Department of Neurological Surgery, University of Washington, Seattle, Washington.
Harborview Injury Prevention Research Center, Harborview Medical Center, Seattle, Washington.
Neurosurgery. 2018 Oct 1;83(4):732-739. doi: 10.1093/neuros/nyx470.
Post-traumatic hydrocephalus (PTH) is a potentially treatable cause of poor recovery from traumatic brain injury (TBI) that remains poorly understood, particularly among children.
To better understand the risk factors for pediatric PTH using a large, multi-institutional database.
We conducted a retrospective cohort study using administrative data from 42 pediatric hospitals participating in the Pediatric Health Information System. All patients ≤21 yr surviving a hospitalization with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for TBI were identified. The primary outcome was PTH, defined by an ICD-9-CM procedure code for surgical management of hydrocephalus within 6 mo. Data were analyzed using multivariable logistic regression.
We identified 91 583 patients ≤21 yr with TBI, 846 of whom developed PTH. Odds of PTH were significantly higher in children <1 yr compared to older age groups. A total of 48.7% of PTH cases were victims of abuse (adjusted odds ratio [aOR] 2.62, 95% confidence interval [CI] 2.16-3.18). PTH was more common after craniotomy (aOR 1.60, 95% CI 1.30-1.97). Craniectomy without early cranioplasty was associated with markedly increased odds of PTH (aOR 3.67, 95% CI 2.66-5.07), an effect not seen in those undergoing cranioplasty within 30 d (aOR 1.19, 95% CI 0.75-1.89).
PTH was seen in 0.9% of children who sustained a TBI and was more common in those <1 yr. Severe injury, abuse, and craniectomy with delayed cranioplasty were associated with greatly increased likelihood of PTH. Early cranioplasty in children who require craniectomy may reduce the risk for PTH.
创伤性脑损伤（TBI）后脑积水（PTH）是一种可能导致 TBI 恢复不佳的治疗性疾病，但人们对其了解甚少，尤其是在儿童中。
利用大型多机构数据库更好地了解小儿 PTH 的危险因素。
我们使用参与小儿健康信息系统的 42 家儿童医院的行政数据进行了回顾性队列研究。所有在 TBI 住院期间有国际疾病分类，第 9 版临床修订版（ICD-9-CM）编码的患儿，均被定义为生存患儿。主要结局为 6 个月内手术治疗脑积水的 ICD-9-CM 操作代码定义的 PTH。使用多变量逻辑回归进行数据分析。
我们确定了 91583 名≤21 岁的 TBI 患儿，其中 846 名患儿发生 PTH。与年龄较大的患儿相比，1 岁以下患儿发生 PTH 的可能性显著更高。共有 48.7%的 PTH 病例为虐待受害者（调整优势比[aOR]2.62，95%置信区间[CI]2.16-3.18）。开颅术后 PTH 更常见（aOR 1.60，95%CI 1.30-1.97）。行去骨瓣减压术但未早期行颅骨成形术与 PTH 发生风险显著增加相关（aOR 3.67，95%CI 2.66-5.07），而在 30d 内行颅骨成形术者则未见此现象（aOR 1.19，95%CI 0.75-1.89）。
0.9%的 TBI 患儿发生 PTH，且年龄越小越常见。严重损伤、虐待和去骨瓣减压术伴延迟颅骨成形术与 PTH 发生风险显著增加相关。在需要行去骨瓣减压术的患儿中早期行颅骨成形术可能会降低 PTH 的发生风险。
