title: The Association Between Ventriculo-Peritoneal Shunt and Acute Appendicitis in Patients with Traumatic Brain Injury: A 14-Year, Population-Based Study.
abstract: OBJECTIVE
  The association between preexisting ventriculoperitoneal (VP) shunt and the risk of new-onset acute appendicitis in patients with traumatic brain injury (TBI) is not well established. The aim of the present study was to determine the relationships between VP shunt and acute appendicitis in patients with TBI.
  
  
  METHODS
  A longitudinal cohort study matched by a propensity score in patients with TBI with (4781 patients) or without (9562 patients) VP shunt was conducted using the National Health Insurance Research Database in Taiwan between January 1993 and December 2013.
  
  
  RESULTS
  The main outcome studied was diagnosis of acute appendicitis. The cumulative probability of acute appendicitis was not different between these 2 groups (P = 0.6244). A Cox model showed central nervous system (CNS) infection to be an independent predictor of acute appendicitis with an adjusted hazard ratio of 2.98. Patients with TBI with both a VP shunt and a CNS infection had a greater risk of developing new-onset acute appendicitis (hazard ratio 4.25; 95% confidence interval 1.84-9.81) compared patients with TBI without a VP shunt or CNS infection.
  
  
  CONCLUSIONS
  We concluded that VP shunt is not a risk factor in the development of appendicitis in patients with TBI. Patients with TBI with a shunt and a CNS infection may have a greater risk of developing acute appendicitis. Therefore, care in avoiding CNS infection is a key for the prevention acute appendicitis in this patient population.
authors.affiliation: Department of Neurosurgery, Chi-Mei Hospital, Chiali, Tainan, Taiwan; Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan.
authors.forename: Sher-Wei
authors.initials: SW
authors.lastname: Lim
authors.affiliation: Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Kam-Hou
authors.initials: KH
authors.lastname: Ao
authors.affiliation: Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
authors.forename: Chung-Han
authors.initials: CH
authors.lastname: Ho
authors.affiliation: Department of General Surgery, Chi-Mei Hospital, Chiali, Tainan, Taiwan.
authors.forename: Chien-Jen
authors.initials: CJ
authors.lastname: Tseng
authors.affiliation: Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Jhi-Joung
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Chung-Ching
authors.initials: CC
authors.lastname: Chio
authors.affiliation: Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan. Electronic address: kuojinnrung@gmail.com.
authors.forename: Jinn-Rung
authors.initials: JR
authors.lastname: Kuo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000453:epidemiology*; D000070642:Brain Injuries, Traumatic / Q000453:epidemiology / Q000601:surgery*; D016022:Case-Control Studies; D002494:Central Nervous System Infections / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D013624:Taiwan / Q000453:epidemiology; D017287:Ventriculoperitoneal Shunt; D055815:Young Adult
keywords: Acute appendicitis; Central nervous system infection; Population-based; Traumatic brain injury; Ventriculo-peritoneal shunt