Khan 2010.

Study characteristics
Methods	Study design: parallel‐group randomised trial Study dates: study dates not available Setting: inpatient procedure ‐ outpatient follow‐up Country: India
Participants	Inclusion criteria: participants between 20 days to 8 months, with progressive hydrocephalus with or without neural tube defect (NTD). The most common cause of hydrocephalus in children without NTD was aqueductal stenosis. Exclusion criteria: patients having meningitis, ventriculitis, hydrocephalus secondary to mass lesions, intraventricular haemorrhage, peritoneal infection or peritoneal adhesions Sample size: 40 eligible were randomly allocated using random number table. Patients: 26 NTD hydrocephalus and 14 without NTD Age (years): Group A: Anti‐siphon group (20 days to 8 months, mean 3.5) Group B: Non‐antisyphon (25 days to 8 months) Sex (M/F) Group A: 6 female, 14 male; Group B: 5 female, 15 male Relevant participant details: Group A: Neural tube defect 35% Low shunt pressure 85% Medium shunt pressure 15% Group B: Neural tube defect 35% Slow shunt pressure 80% Medium shunt pressure 20%
Interventions	Group A (n = 20): with anti‐syphon device (Vygon) Group B (n = 20): without anti‐syphon device (Chhabra and Ceredrain)
Outcomes	Treatment failure How measured: number of participants with shunt block, shunt infection and over‐drainage Time points measured: 3 and 6 months Time points reported: unclear (possibly 6 months) Adverse events (morbidity) How measured: number of participants with shunt block, shunt infection and over‐drainage Time points measured: 3 and 6 months Time points reported: unclear (possibly 6 months) Head circumference How measured: Occipito frontal circumference (OFC) Time points measured: at discharge, 3 and 6 months postoperative Time points reported: at discharge, 3 and 6 months postoperative Ventricular size How measured: Modified Evan’s index (MEI) assessed by computerised tomography Time points measured: at discharge, 3 and 6 months postoperative Time points reported: at discharge, 3 and 6 months postoperative Mortality for all causes: not reported Quality of life: not reported
Funding sources	Not available
Declarations of interest	Not available
Notes	No description was made about why surgeons chose different pressures and little information is provided on the types of valves used. Contact information: drrizwanahmadkhan@yahoo.co.in (R.A. Khan).
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"Patients were randomly allocated to the two groups of the shunts using random number table."
Allocation concealment (selection bias)	Unclear risk	No information available. Insufficient information to permit judgement of ‘Low risk’ or ‘High risk’
Blinding of participants and personnel (performance bias) Subjective outcomes: treatment failure, adverse events, quality of life	High risk	No information about blinding available, however blinding was unlikely due to the visibly different interventions.
Blinding of participants and personnel (performance bias) Objective outcomes: mortality, head circumference, ventricular size	Low risk	No information about blinding available. Outcomes were likely to be unaffected by blinding.
Blinding of outcome assessment (detection bias) Subjective outcomes: treatment failure, adverse events, quality of life	High risk	No information about blinding available, however blinding was unlikely due to the visibly different interventions.
Blinding of outcome assessment (detection bias) Objective outcomes: mortality, head circumference, ventricular size	Low risk	No information about blinding available. Outcomes were likely to be unaffected by blinding.
Incomplete outcome data (attrition bias) All outcomes	Low risk	All outcomes: outcome data were available for all participants.
Selective reporting (reporting bias)	Unclear risk	Insufficient information to permit judgement of ‘Low risk’ or ‘High risk’ (no protocol available)
Other bias	Low risk	No other sources of bias were identified.