Predicting the outcomes of shunt implantation in patients with post-traumatic hydrocephalus and severe conscious disturbance: a scoring system based on clinical characteristics.

Yadong Wang,Liang Wen,Wangxiao Bao,Wendong You,Hao Wang,Yiran Zhu ,Yungang Sun ,Xiaofeng Yang

doi:10.31083/j.jin.2020.01.1231

Abstract

Post-traumatic hydrocephalus is a common complication secondary to traumatic brain injury. It can cause cerebral metabolic impairment and dysfunction. Therefore, timely treatment with shunt implantation is necessary. However, the outcomes of shunt surgery in patients with post-traumatic hydrocephalus combined with disturbance of consciousness are doubtful. The objective was to develop a predictive model that uses the information available before surgery to predict the outcome of shunt implantation in such patients. Retrospectively collected data were used to develop a clinical prediction model. The model was derived from 59 patients using logistic regression analysis, and then it was evaluated by the area under the receiver operating characteristic curve and Hosmer-Lemshow test. A validation cohort verified the model. Four independent predictors were identified: age < 50 years, mild hydrocephalus, Glasgow Coma Scale scores 9-12 at the time of injury, and time interval from trauma to shunting < 3 months. We calculated the total score and defined the patients into three groups: low-probability (0-10 points), medium-probability (11-16 points), and high-probability (17-30 points). The rates of improved outcomes in the three groups were 14.3%, 52.6%, and 94.7%, respectively (P < 0.0001). The correlative rates of the validation cohort were 21.4%, 54.5%, and 85.7%. The prognostic model showed good discrimination (area under the receiver operating characteristic curve = 0.869) and calibration (Hosmer-Lemshow test, P = 0.391). The developed predictive model can identify patients with post-traumatic hydrocephalus combined with disturbance of consciousness who can benefit from shunt implantation. Therefore, our prognostic model can predict the outcomes of patients with post-traumatic hydrocephalus and disturbance of consciousness after shunt surgery.

Highlights

Post-traumatic hydrocephalus (PTH) was first reported by Dandy and Blackfan (1964)
About 5.48 million people are estimated to suffer from severe traumatic brain injury (TBI) every year all over the world (Iaccarino et al, 2018), of which the majority are afflicted with disorders of consciousness
We developed a prognostic model to predict the outcome of shunt implantation after a two-year follow-up in patients suffering from PTH with a disorder of consciousness

Summary

Introduction

Post-traumatic hydrocephalus (PTH) was first reported by Dandy and Blackfan (1964). It is characterized by progressive expansion of the ventricles secondary to cerebrospinal fluid circulation disorders and brain trauma. PTH is a frequent complication of traumatic brain injury (TBI) that affects brain metabolism and neural function. According to different diagnostic standards, the incidence of PTH reported by other researchers ranges from 0.7% to 50% (Cardoso and Galbraith, 1985; Guyot and Michael, 2000; Mazzini et al, 2003). Patients in a minimally conscious state, vegetative state, and those in a persistent coma after head trauma are more likely to develop PTH (Jennett et al, 2001)

Methods

Results

Discussion

Conclusion