837 Shunt-dependent Post Traumatic Hydrocephalus in Pediatric Patients with Moderate to Severe Traumatic Brain Injury (TBI)

Abstract

INTRODUCTION: Post-traumatic hydrocephalus (PTH) is a sequela of traumatic brain injury (TBI) causing significant morbidity among patients and treatment often requires placement of ventriculoperitoneal (VP) shunts. It is especially concerning in children given the often-lifelong dependency and quality-of-life issues over their life course. METHODS: The Nationwide Inpatient Sample 2000-2014 was queried and patients =18 years with moderate-severe TBI identified using ICD-9-CM codes. Weighted-data was analyzed and outcomes examined. RESULTS: A total 328,971 pediatric TBI cases were identified. Most patients were male (67.26%). The mean patient age was 9.74 years (SD=6.63), median 12 years (IQR=3-16). Age-group categories were: <1-year (14.58%), 1-9 years (30.14%), 10-19 years (55.28%). Majority of cases were treated at teaching hospitals (81.98%). The most common injury-causes were falls (20.35%) followed by motor-vehicle accidents (18.47%). Approximately 1.47% developed PTH requiring VP-shunt placement. By age-group, VP-shunt placement occurred in <1-year (3.69%), 1-9 years (1.14%), 10-19 years (1.07%), P<0.001. The mean age of patients developing shunt-dependent PTH was 6.95 years (SD=7.08), median age 4 years (IQR=0-14). After multivariate regression, patients with shunt-dependent PTH demonstrated higher odds of inpatient mortality (OR=1.29; 95%CI=1.02-1.62, P<0.001), tracheostomy (OR=5.93; 95%CI=4.75-7.40, P<0.001) and PEG-placement (OR=5.54; 95%CI=4.40-6.96, P<0.001), and also demonstrated significantly higher odds of medical complications including pulmonary insufficiency (OR=2.36; 95%CI=1.98-2.81, P<0.001), acute respiratory failure (OR=2.58; 95%CI=2.15-3.10, P<0.001), deep-vein thrombosis (OR=5.42; 95%CI=3.57-8.21, P<0.001), pulmonary embolism (OR=3.31; 95%CI=1.01-10.82, P=0.04), ventilator associated pneumonia (OR=2.20; 95%CI=1.07-4.52, P<0.001), congestive cardiac failure (OR=4.64; 95%CI=1.81-11.90, P<0.001), acute renal failure (OR=2.57; 95%CI=1.45-4.56, P<0.001), sepsis (OR=2.87; 95%CI=1.49-5.52, P<0.001), and severe sepsis (OR=4.12; 95%CI=1.89-8.97, P<0.001). CONCLUSIONS: Pediatric TBI patients developing shunt-dependent PTH have significantly higher inpatient morbidity and mortality. Research to better understand factors associated with post-traumatic hydrocephalus in pediatric patients are warranted.