Hydrocephalus in Pediatric Traumatic Brain Injury: National Incidence, Risk Factors, and Outcomes in 124,444 Hospitalized Patients

Publication date: Available online 11 December 2017
Source:Pediatric Neurology
Author(s): Kavelin Rumalla, Vijay Letchuman, Kyle A. Smith, Paul M. Arnold
IntroductionHydrocephalus is a life-threatening sequela of traumatic brain injury (TBI) with poorly defined epidemiology in children. Here, we report the national incidence, risk factors, and outcomes associated with post-traumatic hydrocephalus (PTH).MethodsThe Kids Inpatient Database (2003, 2006, 2009, 2012) was queried 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). Variables included patient demographics and comorbidities, TBI severity (level of consciousness, injury type), treatment, and outcome-related measures. Risk factors associated with PTH were identified using univariate and multivariable analysis.ResultsPTH occurred in 1,265 (1.0%) of 124,444 patients hospitalized with TBI and was managed by ventriculoperitoneal shunt (32.7%) and extraventricular drain (10.7%). PTH had highest rates in shaken baby syndrome (6.7%, N=19) and firearm injury (3.4%, N=74). 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%). Multivariable risk factors for PTH included age 0-5 years-old (versus 6-20), Medicaid (versus private), electrolyte disorder, chronic neurological condition, weight loss, subarachnoid hemorrhage, subdural hematoma, open wound, postoperative neurological complication (iatrogenic stroke), and septicemia (P<0.05). PTH rates are higher amongst surgically managed patients (6.0% vs. 0.5%) unless managed within first 24 hours (0.8% vs. 4.1%) (P<0.05). PTH was associated with greater LOS (25 vs. 5 days) and hospital costs ($86,596 vs. $16,791), but lower mortality (1.1% vs. 5.4%).ConclusionPTH in children is relatively uncommon compared to adults. Risk factors identified here, including the influence of surgical intervention, warrant further investigation.



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