Abstract
Objective
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.
Design
Cohort study with retrospective comparative analysis.
Setting
Inpatient rehabilitation hospital.
Participants
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.
Interventions
None.
Main Outcome Measures
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.
Results
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.
Conclusions
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.
Keywords
List of abbreviations:
CSF (cerebrospinal fluid), PTA (posttraumatic amnesia), PTH (posttraumatic hydrocephalus), RLAS (Rancho Los Amigos Scale), TBI (traumatic brain injury), VP (ventriculoperitoneal)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 23, 2016
Footnotes
Supported by the Craig Hospital Foundation.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
