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Maiken Tibæk MD Mia Linneman Med. Stud. & Lars Peter Kammersgaard MD DMSci

Hydrocephalus following severe traumatic brain injury: Incidence and relation to short-term recovery. Maiken Tibæk MD Mia Linneman Med. Stud. & Lars Peter Kammersgaard MD DMSci Department of Neurorehabilitation TBI Unit, Copenhagen University Hospital, Glostrup. Background.

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Maiken Tibæk MD Mia Linneman Med. Stud. & Lars Peter Kammersgaard MD DMSci

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  1. Hydrocephalus following severe traumatic brain injury: Incidence and relation to short-term recovery Maiken Tibæk MD Mia Linneman Med. Stud. & Lars Peter Kammersgaard MD DMSci Department of Neurorehabilitation TBI Unit, Copenhagen University Hospital, Glostrup.

  2. Background • Hydrocephalus (HC) reported in 12-50 % of cases with severe TBI • HC may influence long-term outcome

  3. Setting • 22 bed subacute neurorehabilitation hospital facility • Dedicated interdisciplinary rehabilitation • Well-defined catchment area in eastern Denmark (2.4 million)

  4. Glasgow Coma Score 3-9 GCS 10-12 with severe focal neurological deficits, i.e., hemiparesis, aphasia or severe agitation Severe cognitive disturbance and paresis or agitation Selection criteria

  5. 303 consecutive patients Oct 2000 to December 2008 Clinical data collected prospectively HC retrospectively (case notes) PTA assessed by Galveston Orientation and Amnesia Test (GOAT) Materials and methods

  6. Hydrocephalus • Diagnosed with CT scans • All patients had ventricular shunts installed • HC between time of injury and disharge considered

  7. Statistics • Comparison with vs. without HC by univariate statistics • Adjusted relative influence of HC for duration of PTA by multiple linear regression

  8. Clinical Characteristics for TBI patients with vs. without hydrocephalus *on admission for rehabilitation

  9. Results I • Overall 13% developed HC • Patients with HC - more frequently SAH - longer acute treatment - lower GCS at rehabilitation - longer PTA - longer LOHS

  10. Multiple linear regression, backward method (final model) • Dependent variable: Length of PTA in days, n = 192 • *Glasgow Coma Score on admission for rehabilitation

  11. Results II Hydrocephalus prolonged length of PTA by 63 days independent of age, sex, SAH, duration of sedation, acute stay, and GCS on admission for rehabilitation

  12. Conclusions • HC was found to be a complication in 13 % of severe TBI • HC appears to prolong PTA by a mean of 63 days irrespective of demographics and clinical characteristics • As a complication, HC is not an innocent bystander • Instead, HC delays recovery from TBI

  13. Acknowledgements Thanks to: • All members of the teams for contribution of data • Patients and relatives • Dr. Lars Westergaard for his input on the diagnosis of hydrocephalus

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