Summary of findings 3. Standard valve compared to self‐adjusting CSF flow‐regulating valve for hydrocephalus.

Standard valve compared to self‐adjusting CSF flow‐regulating valve for hydrocephalus
Patient or population: participants with hydrocephalus Setting: inpatient procedure ‐ outpatient follow‐up (Canada, United States, France) Intervention: standard valve Comparison: self‐adjusting CSF flow‐regulating valve
Outcomes	Impact	№ of participants (studies)	Certainty of the evidence (GRADE)
Treatment failure: morbidity associated with shunt placement that led to shunt revision Follow‐up: 2 years	The incidence of treatment failure may be similar in those with the standard valve and the self‐adjusting CSF flow‐regulating valve (RR 1.08, 95% CI 0.79 to 1.47). Standard valve: 42% Self‐adjusting CSF flow‐regulating valve: 39%	229 (1 RCT)	⊕⊕⊝⊝ LOW 1 2
Adverse events: morbidity related to the shunt placement that has not led to shunt revision Follow‐up: 2 years	The incidence of adverse events may be similar in those with the standard valve and those with the self‐adjusting CSF flow‐regulating valve. Range with standard valve: 0–1.9% Range with self‐adjusting CSF flow‐regulating valve: 0–7.2%	229 (1 RCT)	⊕⊕⊝⊝ LOW 1 2
Mortality In the early postoperative period (≤ 30 days)	The included studies reported no events in this period (deaths).	229 (1 RCT)	⊕⊕⊝⊝ LOW 1 2
Mortality Beyond the early postoperative period (> 30 days)	Nine patients died. No disaggregated data by each type of intervention were available.	229 (1 RCT)	⊕⊕⊝⊝ LOW 1 2
Quality of life	Not reported	‐	‐
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; CSF: cerebrospinal fluid; RCT: randomised controlled trial; RR: Risk ratio.
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

¹ Downgraded one level due to high or unclear risk of bias in multiple domains in the included study

² Downgraded one level due to few participants and events in the included study