I would like to thank the AANS and my co-authors for helping me in presenting this work to you today. The title of the work is Risk Factors for Post-Traumatic Hydrocephalus Following Pediatric Traumatic Brain Injury in the Emergency Department Setting. In 2014 alone, nearly 2.8 million nationwide TBI-related ED visits, hospitalizations, and deaths occurred, representing an approximately 53% increase in the ED-associated events over the past decade. Of these events, 837,000 were children. Lifelong complications associated with pediatric TBI have been associated with increased seizure epilepsy, dementia, cranial nerve injuries, and psychiatric complications. Post-traumatic hydrocephalus is a possible complication from TBI. PTH is caused by the disruption of cerebral spinal fluid passage through the ventricular system after injury. It has been associated with increased length of hospitalization and costs. In a recent study by Ramella, in a retrospective study using the KIDS database, the KIDS in patient sample of 124,000 patients admitted after a TBI, they looked at risk factors for PTH. Of these risk factors, they found age 0-5 years old, Medicaid insurance, electrolyte disorder, and weight loss all to be significantly associated with PTH. However, what are the risk factors associated with PTH in patients presenting to the ED following a TBI? The objective of this study was to investigate the national impact of demographic, hospital, and inpatient risk factors on PTH development in the pediatric patients who presented to the ED following a TBI. This was a retrospective study utilizing the HCUP nationwide emergency departmental sample database. We queried between 2010-2014 for all patients less than 21 years old with a primary diagnosis of TBI and a subsequent secondary diagnosis of PTH using the ICD-9 coding. We identified about 1.2 million pediatric patients and retrospectively assessed demographic information and hospital characteristics, clinical comorbidities, etiology of the injuries and type of injuries, complications associated with injuries, with the primary outcome being the development of PTH. When we look at the hospital characteristics and patient demographics of patients with hydrocephalus, we find that of the 1.2 million, 930 patients, 0.07% develop hydrocephalus. Similar to the Romello study, we found that the age group 0-5 had the highest proportion presenting with hydrocephalus as well as Medicaid insurance, income status from 42,000 to 52,000 of the household, urban hospital location, teaching hospital, and trauma center to be of the higher proportions of patients presenting with hydrocephalus. And when we look at the etiology of the injury that occurred, we actually find that while there's a greater number of hydrocephalic patients with no loss of consciousness or a brief loss of consciousness, you actually see a greater proportion being in prolonged loss of consciousness, but returning back to baseline, as well as prolonged loss of consciousness greater than 24 hours and no baseline return. And the type of TBI, we see that subarachnoid hemorrhage as well as subdural hemorrhage were the most prevalent. And when we look at the nature of the injury, while open was the greater proportion, closed had a greater number. And the etiology of the injury being fall as the highest number, but firearm and shaken baby syndrome being the greatest proportion. And when we look at the results of the complications associated with the ED visit as well as the inpatient visit, we find that respiratory was the greatest number, whereas septicemia and other neurologic injuries were the greater proportions. And when we look at how many were admitted to the hospital inpatient, you had the greatest percentage being admitted inpatient being hydrocephalic, and then after their inpatient admission, a lot of them had the higher number was routine discharge, but the greater proportions were actually transferring to a rehab or home healthcare. And when we put all these variables into a multivariate, we find that age in reference to all the other age groups was associated with a greater risk of post-traumatic hydrocephalus. And in terms of loss of consciousness, the prolonged loss of consciousness of 24 hours to baseline return, as well as prolonged 24 hours and no baseline were both high risk factors and predictive of post-traumatic hydrocephalus. And when we look at hospital complications, we find that respiratory as well as hematoma and hemorrhage or hemorrhage and thromboembolic events were all associated with post-traumatic hydrocephalus. And in terms of the injury, we see, of course, open injury being associated. And when we actually look at the outcome variables being length of stay, ED charge and inpatient charge, you actually see that there's a medium increase in length of stay, about nine days for the post-traumatic hydrocephalus cohort. The ED charge was a little bit bigger or a little bit greater for the post-traumatic hydrocephalus, but the inpatient charge for those who were diagnosed with PTH was tenfold, meaning that there is a great cost burden associated with these PTH post-TBI. So in conclusion, our study utilizes the NEDS database and demonstrates various demographic hospital and clinical risk factors associated with the development of hydrocephalus following traumatic brain injury. Enhancing awareness of these drivers may help provide greater awareness of patients likely to develop PTH, such that the complications can decrease the incidence and hopefully improve quality of care and decrease the economic burden associated with PTH. Thank you.

post-traumatic hydrocephalus

pediatric traumatic brain injury

emergency department

risk factors

cerebral spinal fluid