title: Predictors of Shunt Insertion in Aneurysmal Subarachnoid Hemorrhage.
abstract: Hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH), requiring permanent cerebrospinal fluid (CSF) diversion in up to two thirds of patients. Factors that predict permanent CSF diversion are not well established.
  
  
  
  An exploratory analysis of 149 patients enrolled in the CARAS (Cerebral Aneurysm Renin Angiotensin System) study was performed in an effort to identify factors predictive of permanent CSF diversion after aSAH; only the 135 patients surviving the initial hospitalization were included in the present study. CARAS was a prospective, multicenter study investigating the impact of genetic polymorphisms in patients with aSAH and enrolled patients from September 2012 to January 2015.
  
  
  
  One hundred and forty-nine patients with aSAH were enrolled in CARAS, with 135 (90.6%) patients surviving the initial hospitalization. Sixty-four of these patients (47.4%) required permanent CSF diversion. Multivariable analysis identified the following as independent risk factors: sympathomimetic illicit drug use, external ventricular drain (EVD) insertion, and hyponatremia. A scoring system based on EVD insertion (2 points), Hunt and Hess grade (1 point if grade ≥4) and modified Fisher computed tomography grade (1 point if grade 4) produced an area under the curve of 0.8 (P < 0.001).
  
  
  
  Sympathomimetic illicit drug use, EVD insertion, and hyponatremia are the strongest predictors of shunt insertion in patients with aSAH. Moreover, a scoring system based on EVD insertion, Hunt and Hess grade, and modified Fisher computed tomography grade can reliably predict the need for shunt placement in patients with aSAH.
authors.affiliation: Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Rouzbeh
authors.initials: R
authors.lastname: Motiei-Langroudi
authors.affiliation: Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Nimer
authors.initials: N
authors.lastname: Adeeb
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Foreman
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Harrigan
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Winfield S
authors.initials: WS
authors.lastname: Fisher
authors.affiliation: Department of Neurosciences, INOVA Health Systems, Fairfax, Virginia, USA.
authors.forename: Nilesh A
authors.initials: NA
authors.lastname: Vyas
authors.affiliation: Department of Neurosciences, INOVA Health Systems, Fairfax, Virginia, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Lipsky
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Neurosciences, INOVA Health Systems, Fairfax, Virginia, USA.
authors.forename: Beverly C
authors.initials: BC
authors.lastname: Walters
authors.affiliation: Seattle Science Foundation, Seattle, Washington, USA.
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.affiliation: Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Mohammadali M
authors.initials: MM
authors.lastname: Shoja
authors.affiliation: Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Moore
authors.affiliation: Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Raghav
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ogilvy
authors.affiliation: Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ajith J
authors.initials: AJ
authors.lastname: Thomas
authors.affiliation: Neurosurgery Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: christoph.griessenauer@gmail.com.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
mesh_terms: D002557:Cerebrospinal Fluid Shunts / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012084:Renin-Angiotensin System / Q000502:physiology; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D019966:Substance-Related Disorders / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery
keywords: Aneurysm; Hydrocephalus; Predictor; Scoring system; Shunt; Subarachnoid hemorrhage