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Risk factors for posttraumatic hydrocephalus after decompressive hemicraniectomy in pediatric patients with traumatic

Irim Salik1, Sima Vazquez2, Arjun Syal2

  • 1Departments of1Anesthesiology.

Journal of Neurosurgery. Pediatrics
|February 14, 2023
PubMed

Insights

Prolonged mechanical ventilation and external ventricular drain placement before decompressive hemicraniectomy increase the risk of posttraumatic hydrocephalus in pediatric TBI patients. Early identification of these risk factors can improve diagnosis and resource use.

Area of Science:

  • Neurosurgery
  • Pediatric Critical Care
  • Trauma Surgery

Background:

  • Traumatic brain injuries (TBIs) are a major cause of death and disability in children.
  • Decompressive hemicraniectomy (DHC) is a life-saving procedure for severe pediatric TBI (pTBI) when ICP cannot be controlled medically.
  • Posttraumatic hydrocephalus (PTH) is a potential complication of DHC that can impede recovery.

Purpose of the Study:

  • To identify risk factors for developing PTH after DHC in pediatric TBI patients.
  • To analyze the association between specific clinical factors and PTH development.
  • To evaluate the impact of PTH on healthcare resource utilization.

Main Methods:

  • Utilized the Kids' Inpatient Database (KID) from 2016-2019.
  • Queried records for pediatric TBI patients who underwent DHC.
  • Employed multivariate regression to determine risk factors for PTH and shunt insertion, analyzing length of stay and hospital charges.

Main Results:

  • Of 68,793 pTBI patients, 848 underwent DHC. PTH occurred in 12.4% of these patients.
  • Prolonged mechanical ventilation (PMV) and pre-DHC external ventricular drain (EVD) placement were significantly associated with increased PTH risk.
  • DHC performed later in the hospital course (after hospital day 2) was associated with a lower risk of PTH.

Conclusions:

  • PMV, subdural hematoma, and pre-DHC EVD placement are key risk factors for PTH in pediatric TBI patients undergoing DHC.
  • PTH is associated with increased length of stay and hospital costs.
  • Identifying these risk factors aids in early PTH diagnosis and optimizes healthcare resource allocation.
Abstract

Keywords:
CSF diversiondecompressive hemicraniectomymechanical ventilationposttraumatic hydrocephalustraumatic brain injury

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