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Risk factors for posttraumatic hydrocephalus after decompressive hemicraniectomy in pediatric patients with traumatic brain injury

Irim Salik, Sima Vazquez, Arjun Syal, Ankita Das, Ariel Sacknovitz, Eris Spirollari, Jose F. Dominguez, Matthew Wecksell, Dylan Stewart, and Jared M. Pisapia

OBJECTIVE

Traumatic brain injuries (TBIs) play a significant role in pediatric mortality and morbidity. Decompressive hemicraniectomy (DHC) is a treatment option for severe pediatric TBI (pTBI) not amenable to medical management of intracranial pressure. Posttraumatic hydrocephalus (PTH) is a known sequela of DHC that may lead to further injury and decreased capacity for recovery if not identified and treated. The goal of this study was to characterize risk factors for PTH after DHC in patients with pTBI by using the Kids’ Inpatient Database (KID).

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The records collected in the KID from 2016 to 2019 were queried for patients with TBI usingInternational Classification of Diseases, 10th Revisioncodes. Data defining demographics, complications, procedures, and outcomes were extracted. Multivariate regression was used to identify risk factors associated with PTH. The authors also investigated length of stay and hospital charges.

RESULTS

Of 68,793 patients with pTBI, 848 (1.2%) patients underwent DHC. Prolonged mechanical ventilation (PMV) was required in 475 (56.0%) patients with pTBI undergoing DHC. Three hundred (35.4%) patients received an external ventricular drain (EVD) prior to DHC. PTH was seen in 105 (12.4%), and 50 (5.9%) received a ventriculoperitoneal shunt. DHC before hospital day 2 was negatively associated with PTH (OR 0.464, 95% CI 0.267–0.804; p = 0.006), whereas PMV (OR 2.204, 95% CI 1.344–3.615; p = 0.002) and EVD placement prior to DHC (OR 6.362, 95% CI 3.667–11.037; p < 0.001) were positively associated with PTH. PMV (OR 7.919, 95% CI 2.793–22.454; p < 0.001), TBI with subdural hematoma (OR 2.606, 95% CI 1.119–6.072; p = 0.026), and EVD placement prior to DHC (OR 4.575, 95% CI 2.253–9.291; p < 0.001) were independent predictors of ventriculoperitoneal shunt insertion. The mean length of stay and total hospital charges were significantly increased in patients with PMV and in those with PTH.

CONCLUSIONS

PMV, presence of subdural hematoma, and EVD placement prior to DHC are risk factors for PTH in patients with pTBI who underwent DHC. Higher healthcare resource utilization was seen in patients with PTH. Identifying risk factors for PTH may improve early diagnosis and efficient resource utilization.

In开云手机版app下载安装最新版神经外科杂志:儿科开云体育app官方网站下载入口Publish Before Print

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A comparison of treating physician versus independent core lab assessments of post–aneurysm treatment imaging outcomes: an analysis of prospectively collected data from a randomized trial

Devi P. Patra, Arjun Syal, Rudy J. Rahme, Karl R. Abi-Aad, Rohin Singh, Evelyn L. Turcotte, Breck A. Jones, Jenna Meyer, Miles Hudson, Brian W. Chong, Guilherme Dabus, Robert F. James, Chandan Krishna, and Bernard R. Bendok

OBJECTIVE

Aneurysm occlusion has been used as surrogate marker of aneurysm treatment efficacy. Aneurysm occlusion scales are used to evaluate the outcome of endovascular aneurysm treatment and to monitor recurrence. These scales, however, require subjective interpretation of imaging data, which can reduce the utility and reliability of these scales and the validity of clinical studies regarding aneurysm occlusion rates. Use of a core lab with independent blinded reviewers has been implemented to enhance the validity of occlusion rate assessments in clinical trials. The degree of agreement between core labs and treating physicians has not been well studied with prospectively collected data.

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In this study, the authors analyzed data from the Hydrogel Endovascular Aneurysm Treatment (HEAT) trial to assess the interrater agreement between the treating physician and the blinded core lab. The HEAT trial included 600 patients across 46 sites with intracranial aneurysms treated with coiling. The treating site and the core lab independently reviewed immediate postoperative and follow-up imaging (3–12 and 18–24 months, respectively) using the Raymond-Roy occlusion classification (RROC) scale, Meyer scale, and recanalization survey. A post hoc analysis was performed to calculate interrater reliability using Cohen’s kappa. Further analysis was performed to assess whether degree of agreement varied on the basis of various factors, including scale used, timing of imaging, size of the aneurysm, imaging modality, location of the aneurysm, dome-to-neck ratio, and rupture status.

RESULTS

Minimal interrater agreement was noted between the core lab reviewers and the treating physicians for assessing aneurysm occlusion using the RROC grading scale (k = 0.39, 95% CI 0.38–0.40) and Meyer scale (k = 0.23, 95% CI 0.14–0.38). The degree of agreement between groups was slightly better but still weak for assessing recanalization (k = 0.45, 95% CI 0.38–0.52). Factors that significantly improved degree of agreement were scales with fewer variables, greater time to follow-up, imaging modality (digital subtraction angiography), and wide-neck aneurysms.

CONCLUSIONS

Assessment of aneurysm treatment outcome with commonly used aneurysm occlusion scales suffers from risk of poor interrater agreement. This supports the use of independent core labs for validation of outcome data to minimize reporting bias. Use of outcome tools with fewer point categories is likely to provide better interrater reliability. Therefore, the outcome assessment tools are ideal for clinical outcome assessment provided that they are sensitive enough to detect a clinically significant change.

InJournal of Neurosurgery Publish Before Print

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