Rumalla K, et al. - Physicians performed this study to describe the national incidence, risk factors, and outcomes associated with post-traumatic hydrocephalus (PTH). Compared to adults, PTH was relatively uncommon in children. They determined the following as risk factors: Age, Medicaid, electrolyte disorder, chronic neurological condition, weight loss, subarachnoid hemorrhage, subdural hematoma, open wound, postoperative neurological complication (iatrogenic stroke), and septicemia. The identified risk factors and the influence of surgical intervention required further investigation.

Methods

• The physicians queried the Kids Inpatient Database (2003, 2006, 2009, 2012) using ICD-9-CM codes to identify all patients (age 0-20) with TBI (850.xx-854.xx) and non-congenital hydrocephalus (331.3-331.5, exclude 742.3).
• In this study, variables included patient demographics and comorbidities, TBI severity (level of consciousness, injury type), treatment, and outcome-related measures.
• They identified risk factors associated with PTH using univariate and multivariable analysis.

Results

• Out of 124,444 patients who were hospitalized with TBI, PTH occurred in 1,265 (1.0%).
• They were managed by ventriculoperitoneal shunt (32.7%) and extraventricular drain (10.7%).
• Shaken baby syndrome (6.7%, N=19) and firearm injury (3.4%, N=74) displayed highest rates of PTH.
• PTH varied by type of TBI: subdural hematoma (2.4%), subarachnoid hemorrhage (1.4%), epidural hematoma (1.0%), cerebral laceration (0.9%), concussion (0.2%).
• Age 0-5 years-old (vs 6-20), Medicaid (vs private), electrolyte disorder, chronic neurological condition, weight loss, subarachnoid hemorrhage, subdural hematoma, open wound, postoperative neurological complication (iatrogenic stroke), and septicemia (P < 0.05) were included as multivariable risk factors for PTH.
• Higher rates of PTH were observed in surgically managed patients (6.0% vs 0.5%) unless managed within first 24 hours (0.8% vs 4.1%) (P < 0.05).
• As per findings, PTH was correlated with greater LOS (25 vs 5 days) and hospital costs ($86,596 vs $16,791), but lower mortality (1.1% vs 5.4%).