Predictors of Ventriculoperitoneal Shunting after Spontaneous Intraparenchymal Hemorrhage

Abstract

Intraparenchymal hemorrhage (IPH) is a serious medical condition with high morbidity. Hydrocephalus complicates the course of IPH recovery and frequently necessitates permanent cerebrospinal fluid (CSF) diversion by ventriculoperitoneal shunting (VPS). Risk factors for VPS have not been studied in adults after IPH. This is a nonrandomized retrospective study aimed to determine risk factors for VPS among IPH patients seen at Barrow Neurological Institute over a 2-year period. Chart review collected pertinent demographic and radiological data for all IPH patients. This data underwent statistical analysis to discover those factors associated with VPS requirements. A predictive shunting instrument was then constructed to determine those patients at greatest risk of VPS requirement. Initial Glasgow Coma Scale score < 9 (P = 0.033), abundant blood in the lateral ventricle (P = 0.016), ICP elevations > 25 mmHg (P = 0.016), persistent ICP elevations > 20 mmHg (P = 0.017), and thalamic IPH location (P = 0.009) were associated with VPS on univariate analysis. Thalamic IPH location (P = 0.025) and ICP > 25 mm Hg (P = 0.025) were associated with VPS on multivariate analysis. Application of a predictive shunting instrument to the cohort had positive predictive value of 100% and a negative predictive value of 81%. A predictive shunting instrument utilizing GCS score, lateral ventricle blood, ICP measurement, and the presence of hydrocephalus may predict those patients at risk for VPS or identify those patients requiring additional CSF drainage strategies.