Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • collapse/seizures/vomiting/altered level of consciousness/new neurological deficit
  • abdominal pain or swelling in a shunted patient
  • acute hydrocephalus
  • clinical suspicion of shunt infection
  • suspected or proven blocked ventriculoperitoneal (VP) shunt
  • swelling pain or redness along shunt tract
  • in the case of suspected raised intracranial pressure without any of the above features – see clinical management advice

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Southern Adelaide Local Health Network

Exclusions

  • asymptomatic, treated hydrocephalus patients without one of the following:
    • clinical deterioration/new symptoms
    • transfer of care (interstate/international)
    • transition of care from paediatric service

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • headaches with papilloedema and / or visual field defects or optimal coherence tomography (OCT) abnormalities identified by an optometrist/ophthalmologist
  • suspected complications of an in-situ ventriculoperitoneal (VP) / lumboperitoneal (LP) shunt

Category 2 (appointment clinically indicated within 90 days)

  • history of treated hydrocephalus with headaches but without other symptoms of raised intracranial pressure
  • hydrocephalus with suspected normal pressure
  • incidental hydrocephalus confirmed with imaging

Category 3 (appointment clinically indicated within 365 days)

  • asymptomatic, shunted patients with one of the following:
    • transfer of care (interstate/international)
    • transition of care from paediatric service

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • relevant past medical/surgical history
  • current medications, allergies
  • history of presenting complaint including:
    • onset
    • duration
    • concerning features
    • type/make of shunt - if possible, check previous records, or patient may have implant card
    • past surgical procedures and year/s completed
    • additional treatments and management including frequency and outcomes
    • previous treating neurosurgeon including location and reason not returning for ongoing care
    • relevant reports or discharge summaries
  • neurological examination findings
  • computed tomography (CT) or medical resonance imaging (MRI) brain
  • confirmation of diagnosis on imaging and associated reports including location, company, and accession number

Additional information to assist triage categorisation

  • eye examination - ophthalmologist/optometrist report

Clinical management advice

Features of raised intracranial pressure may include:

  • severe and increasing headaches
  • headaches worse in the morning
  • headache exacerbated by coughing, sneezing, straining or bending forwards
  • papilloedema
  • pulsatile tinnitus
  • visual symptoms – including transient reduction in vision with straining

In the case of suspected raised intracranial pressure but without any criteria for referral to emergency:

  • arrange urgent eye examination to an ophthalmologist/optometrist
  • arrange urgent cerebral imaging to exclude space occupying lesion or cerebral venous sinus thrombosis.

If features of raised intracranial pressure with normal cerebral imaging and normal neurological examination, consider idiopathic intracranial hypertension and refer urgently to neurology for consideration of investigation and management. See Headache - Neurology CPC.

It is crucial to transfer the care of individuals who have previously been diagnosed and treated for hydrocephalus, especially those who have recently relocated from interstate, or are transitioning from paediatric services. This transfer ensures that relevant medical history and previous imaging scans are accessible in the event of an emergency presentation. Interpretation of imaging for patients with hydrocephalus can be challenging when considered in isolation. Assessing the person in advance helps clinicians to understand their shunt system during acute presentations.Once a baseline has been established, routine reviews are unnecessary, unless there is a decline in clinical condition or a specialist's assessment is clinically required.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.