Abstract
Background: Hydrocephalus among Severe Acquired Brain Injury (SABI) patients remains overlooked during rehabilitation. Methods: A retrospective cohort study was carried out of traumatic and non-traumatic SABI patients with hydrocephalus, consecutively admitted over 9 years in a tertiary referral specialized rehabilitation hospital. Patients were treated with ventriculoperitoneal shunt before or during inpatient rehabilitation and assessed using the Level of Cognitive Functioning Scale and Disability Rating Scale. Logistic regression models were used to identify predictors of post-surgical complications. Linear regression models were used to investigate predictors of hospital length of stay (LOS), disability, and cognitive function. Results: Of the 82 patients, 15 had post-surgical complications and 16 underwent cranioplasty. Shunt placement complication risk was higher when fixed vs. when programmable pressure valves were used. A total of 56.3% achieved functional improvement at discharge and 88.7% improved in cognitive function; of the 82 patients, 56% were discharged home. In multiple regression analyses, higher disability at discharge was related to cranioplasty and longer LOS, while poorer cognitive function was associated with cranioplasty. Increase in LOS was associated with increasing time to shunt and decreasing age. Conclusions: A significant improvement in cognitive and functional outcomes can be achieved. Cranioplasty increased LOS, and fixed pressure valves were related to poorer outcomes.
Highlights
Severe Acquired Brain Injury (SABI) includes a variety of traumatic or non-traumatic acute brain lesions characterized by the onset of a variably long-lasting state of coma (Glasgow Coma Scale—GCS ≤ 8) together with simultaneous motor, sensory, cognitive and/or behavioral impairment
The risk of developing complications after shunt placement was higher among patients with fixed pressure valves compared with those with programmable pressure valves (OR = 16.1, 95%CI: 3.1–84.4, p = 0.002) and decreased with age (OR = 0.94, 95%CI: 0.90–0.99, p = 0.008) (Table 2)
We found an increase in length of stay (LOS) because of an increase in time between hydrocephalus diagnosis and treatment
Summary
Severe Acquired Brain Injury (SABI) includes a variety of traumatic or non-traumatic acute brain lesions characterized by the onset of a variably long-lasting state of coma (Glasgow Coma Scale—GCS ≤ 8) together with simultaneous motor, sensory, cognitive and/or behavioral impairment. Hydrocephalus rate during inpatient rehabilitation ranges from 30% to 86% (between 3 and 12 months after severe brain injury [3,6]). Hydrocephalus among Severe Acquired Brain Injury (SABI) patients remains overlooked during rehabilitation. Methods: A retrospective cohort study was carried out of traumatic and non-traumatic SABI patients with hydrocephalus, consecutively admitted over 9 years in a tertiary referral specialized rehabilitation hospital. Patients were treated with ventriculoperitoneal shunt before or during inpatient rehabilitation and assessed using the Level of Cognitive Functioning Scale and Disability Rating Scale. Linear regression models were used to investigate predictors of hospital length of stay (LOS), disability, and cognitive function. Higher disability at discharge was related to cranioplasty and longer LOS, while poorer cognitive function was associated with cranioplasty. Cranioplasty increased LOS, and fixed pressure valves were related to poorer outcomes
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