Weintraub Alan H, Gerber Donald J, Kowalski Robert G
CNS Medical Group, Englewood, CO; Research Department, Craig Hospital, Englewood, CO.
Research Department, Craig Hospital, Englewood, CO.
Arch Phys Med Rehabil. 2017 Feb;98(2):312-319. doi: 10.1016/j.apmr.2016.08.478. Epub 2016 Sep 23.
To describe incidence, clinical characteristics, complications, and outcomes in posttraumatic hydrocephalus (PTH) after traumatic brain injury (TBI) for patients treated in an inpatient rehabilitation program.
Cohort study with retrospective comparative analysis.
Inpatient rehabilitation hospital.
All patients admitted for TBI from 2009 to 2013 diagnosed with PTH (N=59), defined as ventriculomegaly, delayed clinical recovery discordant with injury severity, hydrocephalus symptoms, or positive lumbar puncture results.
None.
Primary measures were incidence of PTH and patient and injury characteristics. Secondary measures included frequency and timing of ventriculoperitoneal (VP) shunt, related complications, emergence from and duration of posttraumatic amnesia (PTA), Rancho Los Amigos Scale (RLAS) score, and FIM score at rehabilitation admission and discharge.
Of 701 patients with TBI admitted, 59 (8%) were diagnosed with PTH. Of these, the median age was 25 years, with 73% being men. At initial presentation, 52 (88%) did not follow commands. Fifty-two (90%) patients with PTH had a VP shunt placed. Median time from injury to shunt placement was 69 (range, 9-366) days. Seven (12%) patients with PTH experienced postsurgical seizure, 3 (6%) had shunt infection, and 7 (12%) had shunt malfunction. Thirty-six (61%) patients with PTH emerged from PTA during rehabilitation. Median total FIM score at rehabilitation admission was 20 (range, 18-76), and at discharge it was 43 (range, 18-118). Injury severity predicted outcome at rehabilitation admission, whereas shunt timing predicted outcome at rehabilitation discharge.
Incidence of PTH was observed in 8% of patients with TBI in inpatient rehabilitation. Earlier shunting predicted improved outcome during rehabilitation. Future studies should prospectively examine clinical decision rules, type, and timing of intervention and the coeffectiveness of rehabilitation treatment on outcomes.
描述在住院康复项目中接受治疗的创伤性脑损伤（TBI）患者创伤后脑积水（PTH）的发病率、临床特征、并发症及预后情况。
采用回顾性比较分析的队列研究。
住院康复医院。
2009年至2013年因TBI入院且诊断为PTH的所有患者（N = 59），PTH定义为脑室扩大、临床恢复延迟与损伤严重程度不符、脑积水症状或腰椎穿刺结果呈阳性。
无。
主要指标为PTH的发病率以及患者和损伤特征。次要指标包括脑室腹腔（VP）分流术的频率和时间、相关并发症、创伤后遗忘（PTA）的苏醒情况和持续时间、兰乔斯阿米戈斯量表（RLAS）评分以及康复入院和出院时的FIM评分。
在701例入院的TBI患者中，59例（8%）被诊断为PTH。其中，中位年龄为25岁，73%为男性。初次就诊时，52例（88%）患者对指令无反应。52例（90%）PTH患者接受了VP分流术。从受伤到分流术的中位时间为69天（范围9 - 366天）。7例（12%）PTH患者术后发生癫痫，3例（6%）发生分流感染，7例（12%）出现分流故障。36例（61%）PTH患者在康复期间从PTA中苏醒。康复入院时FIM总分中位数为20分（范围18 - 76分），出院时为43分（范围18 - 118分）。损伤严重程度可预测康复入院时的预后，而分流时间可预测康复出院时的预后。
在住院康复的TBI患者中，PTH的发病率为8%。早期分流可预测康复期间预后改善。未来研究应前瞻性地研究临床决策规则、干预类型和时间以及康复治疗对预后的协同有效性。
