title: Predictors of long-term shunt-dependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion.
abstract: OBJECTIVE
  Intracerebral hemorrhage (ICH) is frequently complicated by acute hydrocephalus, necessitating emergency CSF diversion with a subset of patients, ultimately requiring long-term treatment via placement of permanent ventricular shunts. It is unclear what factors may predict the need for ventricular shunt placement in this patient population.
  
  
  METHODS
  The authors performed a retrospective analysis of a prospective database (ICH Outcomes Project) containing patients with nontraumatic ICH admitted to the neurological ICU at Columbia University Medical Center between January 2009 and September 2011. A multiple logistic regression model was developed to identify independent predictors of shunt-dependent hydrocephalus after ICH. The following variables were included: patient age, admission Glasgow Coma Scale score, temporal horn diameter on admission CT imaging, bicaudate index, admission ICH volume and location, intraventricular hemorrhage volume, Graeb score, LeRoux score, third or fourth ventricle hemorrhage, and intracranial pressure (ICP) and ventriculitis during hospital stay.
  
  
  RESULTS
  Of 210 patients prospectively enrolled in the ICH Outcomes Project, 64 required emergency CSF diversion via placement of an external ventricular drain and were included in the final cohort. Thirteen of these patients underwent permanent ventricular CSF shunting prior to discharge. In univariate analysis, only thalamic hemorrhage and elevated ICP were significantly associated with the requirement for permanent CSF diversion, with p values of 0.008 and 0.033, respectively. Each remained significant in a multiple logistic regression model in which both variables were present.
  
  
  CONCLUSIONS
  Of patients with ICH requiring emergency CSF diversion, those with persistently elevated ICP and thalamic location of their hemorrhage are at increased odds of developing persistent hydrocephalus, necessitating permanent ventricular shunt placement. These factors may assist in predicting which patients will require permanent CSF diversion and could ultimately lead to improvements in the management of this disorder and the outcome in patients with ICH.
authors.affiliation: Departments of Neurological Surgery, Mount Sinai Hospital, New York, New York 10032, USA. bez2103@columbia.edu
authors.forename: Brad E
authors.initials: BE
authors.lastname: Zacharia
authors.forename: Kerry A
authors.initials: KA
authors.lastname: Vaughan
authors.forename: Zachary L
authors.initials: ZL
authors.lastname: Hickman
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Bruce
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Carpenter
authors.forename: Nils H
authors.initials: NH
authors.lastname: Petersen
authors.forename: Stacie
authors.initials: S
authors.lastname: Deiner
authors.forename: Neeraj
authors.initials: N
authors.lastname: Badjatia
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D002557:Cerebrospinal Fluid Shunts / Q000639:trends; D015331:Cohort Studies; D016208:Databases, Factual; D004632:Emergency Medical Services / Q000639:trends; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D013995:Time