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Post-Traumatic Hydrocephalus in Children: A Retrospective Study in 42 Pediatric Hospitals Using the Pediatric Health
Robert H Bonow1,2, Assaf P Oron3, Brian W Hanak1
1Department of Neurological Surgery, University of Washington, Seattle, Washington.
Insights
Post-traumatic hydrocephalus (PTH) in children is linked to severe traumatic brain injury (TBI), abuse, and delayed cranioplasty. Early cranioplasty may reduce PTH risk in pediatric TBI patients.
Area of Science:
- Pediatric Neurosurgery
- Trauma Surgery
- Pediatric Critical Care
Background:
- Post-traumatic hydrocephalus (PTH) is a complication of traumatic brain injury (TBI) that can impede recovery, especially in children.
- Understanding risk factors for pediatric PTH is crucial for improving outcomes after TBI.
Purpose of the Study:
- To identify risk factors associated with the development of pediatric post-traumatic hydrocephalus (PTH).
- To analyze the incidence and predictors of PTH in a large cohort of pediatric TBI survivors.
Main Methods:
- Retrospective cohort study utilizing administrative data from 42 pediatric hospitals.
- Identified patients ≤21 years old surviving TBI hospitalization using ICD-9-CM codes.
- Defined PTH by surgical management codes within 6 months; analyzed using multivariable logistic regression.
Main Results:
- 91,583 pediatric TBI patients were analyzed; 846 developed PTH (0.9% incidence).
- Infants (<1 year) had significantly higher odds of PTH.
- Abuse (aOR 2.62) and craniotomy (aOR 1.60) increased PTH risk.
- Craniectomy without early cranioplasty showed markedly increased PTH odds (aOR 3.67).
Conclusions:
- Pediatric PTH is associated with severe TBI, abuse, and craniectomy with delayed cranioplasty.
- Early cranioplasty in children undergoing craniectomy may mitigate the risk of developing PTH.
- These findings highlight critical factors influencing PTH development and suggest potential preventive strategies.
Background:
Post-traumatic hydrocephalus (PTH) is a potentially treatable cause of poor recovery from traumatic brain injury (TBI) that remains poorly understood, particularly among children.
Objective:
To better understand the risk factors for pediatric PTH using a large, multi-institutional database.
Methods:
We conducted a retrospective cohort study using administrative data from 42 pediatric hospitals participating in the Pediatric Health Information System. All patients ≤21 yr surviving a hospitalization with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for TBI were identified. The primary outcome was PTH, defined by an ICD-9-CM procedure code for surgical management of hydrocephalus within 6 mo. Data were analyzed using multivariable logistic regression.
Results:
We identified 91 583 patients ≤21 yr with TBI, 846 of whom developed PTH. Odds of PTH were significantly higher in children <1 yr compared to older age groups. A total of 48.7% of PTH cases were victims of abuse (adjusted odds ratio [aOR] 2.62, 95% confidence interval [CI] 2.16-3.18). PTH was more common after craniotomy (aOR 1.60, 95% CI 1.30-1.97). Craniectomy without early cranioplasty was associated with markedly increased odds of PTH (aOR 3.67, 95% CI 2.66-5.07), an effect not seen in those undergoing cranioplasty within 30 d (aOR 1.19, 95% CI 0.75-1.89).
Conclusion:
PTH was seen in 0.9% of children who sustained a TBI and was more common in those <1 yr. Severe injury, abuse, and craniectomy with delayed cranioplasty were associated with greatly increased likelihood of PTH. Early cranioplasty in children who require craniectomy may reduce the risk for PTH.