In reply: congress of neurological surgeons systematic review and evidence-based guidelines on the treatment of pediatric hydrocephalus: update of the 2014 guidelines

Abstract

We appreciate the thoughtful critique1 of our recent publication “Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Treatment of Pediatric Hydrocephalus: Update of the 2014 Guidelines.”2 We must emphasize that our process used a rigorous methodology to update answers to questions asked in the original 2014 guidelines. 3 One question in our original publication regarded the use of antibiotic-impregnated shunts (AISs) in children with hydrocephalus. For this question, we evaluated whether AIS reduced the risk of infection compared to standard shunts. In our update, we found level I evidence that supported our finding, based on the British antibiotic and silver-impregnated catheters for ventriculoperitoneal shunts (BASICS) of AISs.4 In our posed PICO (population, intervention, control, and outcomes) question, we did not evaluate long-term function or mechanical failure related to AIS. The hypothesis that mechanical failure may be caused by masked AIS infections has yet to be proven with published medical evidence. In addition, while the Fragility Index (FI) of the BASICS study may be low, the study was still statistically significant and adequately powered to answer this question