Abstract:
BACKGROUND:Although hydrocephalus is often treated with permanent cerebrospinal fluid (CSF) shunting during hospitalization for acute aneurysmal subarachnoid hemorrhage (SAH), little is known about the development of delayed hydrocephalus. METHODS:Using administrative data on all visits to nonfederal emergency departments and acute care hospitals across California from 2005 to 2010, we identified patients with SAH and discharged without placement of a CSF shunt. Patients were followed for up to 7 years to determine whether they subsequently developed delayed hydrocephalus, as indicated by hospitalization for a permanent CSF diversion procedure. RESULTS:In 8,889 patients discharged with SAH, 116 (1.3 %) went on to develop delayed hydrocephalus. Most (>90 %) diagnoses of delayed hydrocephalus occurred within the first year after discharge. Cox proportional hazards analysis identified microsurgical clipping (hazard ratio 2.0; 95 % confidence interval 1.2-3.3), temporary ventriculostomy placement (2.5; 1.6-4.1), mechanical ventilation (1.7; 1.1-2.8), and discharge to a skilled nursing facility (2.9; 1.8-4.6) as being significantly associated with the development of delayed hydrocephalus. At 1 year after discharge, the cumulative rate of delayed hydrocephalus was 0.9 % (95 % CI, 0.7-1.1 %) for those without temporary ventriculostomy placement during the initial hospitalization, versus 5.7 % (95 % CI, 3.9-8.1 %) in those who had received a temporary ventriculostomy. CONCLUSION:Delayed hydrocephalus after SAH occurs rarely overall, but in a substantial proportion of patients who required temporary ventriculostomy during the initial hospitalization. These results support vigilant surveillance of patients after removal of a temporary ventriculostomy, given the potential of delayed hydrocephalus to impair recovery or even result in clinical deterioration following SAH.
journal_name
Neurocrit Carejournal_title
Neurocritical careauthors
Walcott BP,Iorgulescu JB,Stapleton CJ,Kamel Hdoi
10.1007/s12028-014-0072-ysubject
Has Abstractpub_date
2015-08-01 00:00:00pages
54-8issue
1eissn
1541-6933issn
1556-0961journal_volume
23pub_type
杂志文章abstract:BACKGROUND:Several methods have been proposed to measure cerebrovascular autoregulation (CA) in traumatic brain injury (TBI), but the lack of a gold standard and the absence of prospective clinical data on risks, impact on care and outcomes of implementation of CA-guided management lead to uncertainty. AIM:To formulat...
journal_title:Neurocritical care
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pub_type: 杂志文章
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pub_type: 杂志文章,评审
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pub_type: 杂志文章
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pub_type: 临床试验,杂志文章
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pub_type: 杂志文章
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pub_type: 杂志文章
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pub_type: 临床试验,杂志文章
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更新日期:2005-01-01 00:00:00
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