Hydrocephalus in Pediatric Traumatic Brain Injury: National Incidence, Risk Factors, and Outcomes in 124,444 Hospitalized Patients.

BACKGROUND

Hydrocephalus is a life-threatening sequela of traumatic brain injury (TBI) with poorly defined epidemiology in children. Here, we report the national incidence, risk factors, and outcomes associated with post-traumatic hydrocephalus (PTH).

METHODS

The Kids Inpatient Database (2003, 2006, 2009, 2012) was queried using the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes to identify all patients (age 0 to 20) with TBI (850.xx to 854.xx) and noncongenital hydrocephalus (331.3 to 331.5, exclude 742.3). Variables included patient demographics and comorbidities, TBI severity (level of consciousness, injury type), treatment, and outcome-related measures. Risk factors associated with PTH were identified using univariate and multivariable analyses.

RESULTS

PTH occurred in 1265 of 124,444 patients (1.0%) hospitalized with TBI and was managed by ventriculoperitoneal shunt (32.7%) and extraventricular drain (10.7%). PTH had the highest rate in shaken baby syndrome (6.7%, n = 19) and firearm injury (3.4%, n = 74). PTH varied by type of TBI: subdural hematoma (2.4%), subarachnoid hemorrhage (1.4%), epidural hematoma (1.0%), cerebral laceration (0.9%), concussion (0.2%). Multivariable risk factors for PTH included age zero to five years old (versus six to 20), Medicaid (versus private), electrolyte disorder, chronic neurological condition, weight loss, subarachnoid hemorrhage, subdural hematoma, open wound, postoperative neurological complication (iatrogenic stroke), and septicemia (P < 0.05). PTH rates are higher among surgically managed patients (6.0% vs 0.5%) unless managed within the first 24 hours (0.8% vs 4.1%) (P < 0.05). PTH was associated with greater length of stay (25 days versus five days) and hospital costs ($86,596 vs $16,791), but lower mortality (1.1% vs 5.4%).

CONCLUSIONS

PTH in children is relatively uncommon compared with adults. Risk factors identified here, along with the influence of surgical intervention, warrant further investigation.