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Published on: October 2, 2014
Shunt-Dependent Post-Traumatic Hydrocephalus: Predictors and Long-Term Functional Outcomes
Hao Xu1, Yongfei Dong2, Dejun Bao2
1Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China. xuhao2021@ustc.edu.cn.
Insights
Post-traumatic hydrocephalus (PTH) affects 5.2% of TBI patients. Shunt complications, not the shunt itself, are linked to poor outcomes, highlighting the need for complication prevention and surveillance.
Area of Science:
- Neurosurgery
- Neurology
- Trauma Care
Background:
- Traumatic brain injury (TBI) is a leading cause of death and disability.
- Post-traumatic hydrocephalus (PTH) is a common TBI complication associated with poor neurological outcomes.
- Long-term functional outcomes in patients with shunt dependence after TBI remain unclear.
Purpose of the Study:
- To identify factors associated with PTH development after TBI.
- To determine factors contributing to unfavorable functional outcomes in TBI patients.
- To analyze the occurrence time of PTH.
Main Methods:
- Retrospective analysis of 6279 TBI patients (2012-2022).
- Univariable logistic regression to identify outcome-related factors.
- Log-rank test and Kaplan-Meier analysis for PTH occurrence time.
Main Results:
- PTH developed in 5.2% of TBI patients.
- Factors associated with PTH include intracerebral hematoma, diabetes, longer hospital stay, craniotomy, low GCS, EVD, and DC.
- Unfavorable outcomes were linked to age >80, repeated operations, hypertension, EVD, tracheotomy, and epilepsy.
- Shunt complications, not VPS itself, strongly predict unfavorable outcomes.
Conclusions:
- Minimizing shunt complications is crucial for improving TBI patient outcomes.
- High-risk patients require rigorous radiographic and clinical surveillance for early PTH detection.
- Further research is needed to clarify long-term outcomes after shunt dependence.
Introduction:
As a disorder of the brain in adults and children, traumatic brain injury (TBI) is considered the major cause of mortality and morbidity. As a serious complication of TBI, post-traumatic hydrocephalus (PTH) is commonly identified and significantly associated with neurocognitive impairment, motor dysfunction, and growth impairment. The long-term functional outcomes after shunt dependence are totally not clear.
Methods:
This study included 6279 patients between 2012 and 2022. To identify the unfavorable functional outcomes and the PTH-related factors, we carried out univariable logistic regression analyses. To identify the occurrence time of PTH, we conducted the log-rank test and Kaplan-Meier analysis.
Results:
Mean patient age was 51.03 ± 22.09 years. Of the 6279 patients with TBI, 327 developed PTH (5.2%). Several PTH development-associated factors, such as intracerebral hematoma, diabetes, longer initial hospital stay, craniotomy, low GCS (Glasgow Coma Scale), EVD (external ventricular drain), and DC (decompressive craniectomy) (p < 0.01), were identified. We also analyzed the factors of unfavorable outcomes after TBI including > 80 years, repeated operations, hypertension, EVD, tracheotomy, and epilepsy (p < 0.01). Ventriculoperitoneal shunt (VPS) itself is not an independent factor of the unfavorable outcome but shunt complication is a strong independent factor of unfavorable outcome (p < 0.05).
Conclusion:
We should emphasize the practices that can minimize the risks of shunt complications. Additionally, the rigorous radiographic and clinical surveillance will benefit those patients at high risk of developing PTH.
Trial Registration:
ClinicalTrials.gov identifier, ChiCTR2300070016.
