Post-Traumatic Hydrocephalus as a Confounding Influence on Brain Injury Rehabilitation: Incidence, Clinical Characteristics and Outcomes

Publication date: Available online 23 September 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Alan H. Weintraub, Donald J. Gerber, Robert G. Kowalski
ObjectiveTo describe incidence, clinical characteristics, complications, and outcomes in post-traumatic hydrocephalus (PTH) following traumatic brain injury (TBI) for patients treated in an inpatient rehabilitation program.DesignCohort study with retrospective comparative analysisSettingInpatient rehabilitation hospitalParticipantsAll patients admitted for TBI from 2009 to 2013 diagnosed with PTH, defined as ventriculomegaly, delayed clinical recovery discordant with injury severity, hydrocephalus symptoms, or positive lumbar puncture results.InterventionsNoneMain Outcome MeasuresPrimary measures were incidence of PTH, patient and injury characteristics. Secondary measures included frequency and timing of ventriculoperitoneal (VP) shunt, related complications, emergence from and duration of post-traumatic amnesia (PTA), Rancho Los Amigos Scale (RLAS) score and functional independence measure (FIM^TM), at rehabilitation admission and discharge.ResultsOf 701 TBI patients admitted, 59 (8%) were diagnosed with PTH. Of these, median age was 25 years, with 73% male. At initial presentation, 52 (88%) didn't follow commands. Fifty-two (90%) PTH patients had a VP shunt placed. Median time from injury to shunt placement was 69 days (range, 9-366). Seven (12%) PTH patients experienced post-surgical seizures, 3 (6%) had shunt infection and 7 (12%) shunt malfunction. Thirty six (61%) PTH patients emerged from PTA during rehabilitation. Median total FIM^TM score at rehabilitation admission was 20 (range, 18-76), and at discharge was 43 (range, 18-118). Injury severity predicted outcome at rehabilitation admission, while shunt timing predicted outcome at rehabilitation discharge.ConclusionsIncidence of PTH was observed in 8% of TBI patients 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 co-effectiveness of rehabilitation treatment on outcomes.



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