Incidence and Risk Model of Post-Traumatic Hydrocephalus in Patients with Traumatic Brain Injury

Abstract

ObjectivePost traumatic hydrocephalus (PTH) is a complication following traumatic brain injury (TBI). Early diagnosis and treatment are essential to improving outcomes. We report the incidence and risk factors of PTH in a large TBI population while considering death as a competing risk. MethodsWe conducted a retrospective cohort study on consecutive TBI patients with radiographic intracranial abnormalities admitted to our academic medical center from 2009 to 2015. We assessed patient demographics, perioperative data, and in-hospital data as risk factors for PTH using survival analysis with death as a competing risk. ResultsAmong 7,473 patients, the overall incidence of PTH requiring shunt surgery was 0.94%. The adjusted cumulative incidence was 0.99%. The all-cause cumulative hazard for death was 32.6%, which was considered a competing risk during analysis. Craniectomy (HR 11.53, p<0.001, 95% CI 5.57-223.85), venous sinus injury (HR 4.13, p=0.01, 95% CI 1.53-11.16), and age ≤5 (p<0.001) were significant risk factors for PTH. Glasgow Coma Score (GCS) >13 was protective against shunt placement (HR 0.50, p=0.04, 95% CI 0.26-0.97). Shunt surgery occurred after hospital discharge in 60% of patients. ConclusionsWe describe the incidence and risk factors for PTH in a large TBI population. Most cases of PTH were diagnosed after hospital discharge, suggesting that close follow-up and multi-disciplinary diagnostic vigilance for PTH are needed to prevent morbidity and disability.