Prediction of Shunt Dependency After Intracerebral Hemorrhage and Intraventricular Hemorrhage

Lu Ting Kuo, Hsueh Yi Lu, Jui Chang Tsai, Yong Kwang Tu

Research output: Contribution to journalArticle

Abstract

Background: Spontaneous intracerebral hemorrhage is a disease with high morbidity and mortality. Extension of the hemorrhage into the ventricles is associated with the development of acute hydrocephalus and a poor outcome. Although it can be managed by external ventricular drainage (EVD), a subset of these patients require placement of permanent ventricular shunts. This study aimed to examine the factors on admission that can predict shunt dependency after EVD management. Methods: Seventy-two patients who underwent EVD were included in this study. Seventeen of these patients underwent placement of a ventriculoperitoneal shunt. Variables analyzed included age, intraventricular hemorrhage (IVH) score, bicaudate index, acute hydrocephalus, initial Glasgow Coma Scale scores, and blood volume in each ventricle. Results: In univariate analysis, IVH score (p = 0.020), bicaudate index (p < 0.001), blood volume in lateral ventricles (p = 0.025), blood volume in the fourth ventricle (p = 0.038), and the ratio of blood volume in lateral ventricles to that in third and fourth ventricles (p = 0.003) were significantly associated with persistent hydrocephalus. The best multiple logistic regression model included blood volume parameters and bicaudate index as predictors with the area under a receiver operating characteristic curve of 0.849. The variance inflation factor (VIF) showed that collinearity was not found among predictors. Patients diagnosed with acute hydrocephalus had less blood volume in the lateral ventricles (OR = 0.910) and had more blood volume in the third ventricle (OR = 3.174) and fourth ventricle (OR = 2.126). Conclusions: These findings may promote more aggressive monitoring and earlier interventions for persistent hydrocephalus after intraventricular hemorrhage in patients at risk.

Original languageEnglish
Pages (from-to)233-240
Number of pages8
JournalNeurocritical Care
Volume29
Issue number2
DOIs
Publication statusPublished - Oct 1 2018
Externally publishedYes

Fingerprint

Ventriculoperitoneal Shunt
Cerebral Hemorrhage
Blood Volume
Stroke
Hydrocephalus
Hemorrhage
Fourth Ventricle
Lateral Ventricles
Drainage
Third Ventricle
Logistic Models
Glasgow Coma Scale
Economic Inflation
ROC Curve
Morbidity
Mortality

Keywords

  • External ventricular drainage
  • Intraventricular hemorrhage
  • Outcome
  • Stroke
  • Ventriculoperitoneal shunt

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Prediction of Shunt Dependency After Intracerebral Hemorrhage and Intraventricular Hemorrhage. / Kuo, Lu Ting; Lu, Hsueh Yi; Tsai, Jui Chang; Tu, Yong Kwang.

In: Neurocritical Care, Vol. 29, No. 2, 01.10.2018, p. 233-240.

Research output: Contribution to journalArticle

Kuo, Lu Ting ; Lu, Hsueh Yi ; Tsai, Jui Chang ; Tu, Yong Kwang. / Prediction of Shunt Dependency After Intracerebral Hemorrhage and Intraventricular Hemorrhage. In: Neurocritical Care. 2018 ; Vol. 29, No. 2. pp. 233-240.
@article{5cfd086d338e4524b4350f5ab7d28e96,
title = "Prediction of Shunt Dependency After Intracerebral Hemorrhage and Intraventricular Hemorrhage",
abstract = "Background: Spontaneous intracerebral hemorrhage is a disease with high morbidity and mortality. Extension of the hemorrhage into the ventricles is associated with the development of acute hydrocephalus and a poor outcome. Although it can be managed by external ventricular drainage (EVD), a subset of these patients require placement of permanent ventricular shunts. This study aimed to examine the factors on admission that can predict shunt dependency after EVD management. Methods: Seventy-two patients who underwent EVD were included in this study. Seventeen of these patients underwent placement of a ventriculoperitoneal shunt. Variables analyzed included age, intraventricular hemorrhage (IVH) score, bicaudate index, acute hydrocephalus, initial Glasgow Coma Scale scores, and blood volume in each ventricle. Results: In univariate analysis, IVH score (p = 0.020), bicaudate index (p < 0.001), blood volume in lateral ventricles (p = 0.025), blood volume in the fourth ventricle (p = 0.038), and the ratio of blood volume in lateral ventricles to that in third and fourth ventricles (p = 0.003) were significantly associated with persistent hydrocephalus. The best multiple logistic regression model included blood volume parameters and bicaudate index as predictors with the area under a receiver operating characteristic curve of 0.849. The variance inflation factor (VIF) showed that collinearity was not found among predictors. Patients diagnosed with acute hydrocephalus had less blood volume in the lateral ventricles (OR = 0.910) and had more blood volume in the third ventricle (OR = 3.174) and fourth ventricle (OR = 2.126). Conclusions: These findings may promote more aggressive monitoring and earlier interventions for persistent hydrocephalus after intraventricular hemorrhage in patients at risk.",
keywords = "External ventricular drainage, Intraventricular hemorrhage, Outcome, Stroke, Ventriculoperitoneal shunt",
author = "Kuo, {Lu Ting} and Lu, {Hsueh Yi} and Tsai, {Jui Chang} and Tu, {Yong Kwang}",
year = "2018",
month = "10",
day = "1",
doi = "10.1007/s12028-018-0532-x",
language = "English",
volume = "29",
pages = "233--240",
journal = "Neurocritical Care",
issn = "1541-6933",
publisher = "Humana Press",
number = "2",

}

TY - JOUR

T1 - Prediction of Shunt Dependency After Intracerebral Hemorrhage and Intraventricular Hemorrhage

AU - Kuo, Lu Ting

AU - Lu, Hsueh Yi

AU - Tsai, Jui Chang

AU - Tu, Yong Kwang

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Background: Spontaneous intracerebral hemorrhage is a disease with high morbidity and mortality. Extension of the hemorrhage into the ventricles is associated with the development of acute hydrocephalus and a poor outcome. Although it can be managed by external ventricular drainage (EVD), a subset of these patients require placement of permanent ventricular shunts. This study aimed to examine the factors on admission that can predict shunt dependency after EVD management. Methods: Seventy-two patients who underwent EVD were included in this study. Seventeen of these patients underwent placement of a ventriculoperitoneal shunt. Variables analyzed included age, intraventricular hemorrhage (IVH) score, bicaudate index, acute hydrocephalus, initial Glasgow Coma Scale scores, and blood volume in each ventricle. Results: In univariate analysis, IVH score (p = 0.020), bicaudate index (p < 0.001), blood volume in lateral ventricles (p = 0.025), blood volume in the fourth ventricle (p = 0.038), and the ratio of blood volume in lateral ventricles to that in third and fourth ventricles (p = 0.003) were significantly associated with persistent hydrocephalus. The best multiple logistic regression model included blood volume parameters and bicaudate index as predictors with the area under a receiver operating characteristic curve of 0.849. The variance inflation factor (VIF) showed that collinearity was not found among predictors. Patients diagnosed with acute hydrocephalus had less blood volume in the lateral ventricles (OR = 0.910) and had more blood volume in the third ventricle (OR = 3.174) and fourth ventricle (OR = 2.126). Conclusions: These findings may promote more aggressive monitoring and earlier interventions for persistent hydrocephalus after intraventricular hemorrhage in patients at risk.

AB - Background: Spontaneous intracerebral hemorrhage is a disease with high morbidity and mortality. Extension of the hemorrhage into the ventricles is associated with the development of acute hydrocephalus and a poor outcome. Although it can be managed by external ventricular drainage (EVD), a subset of these patients require placement of permanent ventricular shunts. This study aimed to examine the factors on admission that can predict shunt dependency after EVD management. Methods: Seventy-two patients who underwent EVD were included in this study. Seventeen of these patients underwent placement of a ventriculoperitoneal shunt. Variables analyzed included age, intraventricular hemorrhage (IVH) score, bicaudate index, acute hydrocephalus, initial Glasgow Coma Scale scores, and blood volume in each ventricle. Results: In univariate analysis, IVH score (p = 0.020), bicaudate index (p < 0.001), blood volume in lateral ventricles (p = 0.025), blood volume in the fourth ventricle (p = 0.038), and the ratio of blood volume in lateral ventricles to that in third and fourth ventricles (p = 0.003) were significantly associated with persistent hydrocephalus. The best multiple logistic regression model included blood volume parameters and bicaudate index as predictors with the area under a receiver operating characteristic curve of 0.849. The variance inflation factor (VIF) showed that collinearity was not found among predictors. Patients diagnosed with acute hydrocephalus had less blood volume in the lateral ventricles (OR = 0.910) and had more blood volume in the third ventricle (OR = 3.174) and fourth ventricle (OR = 2.126). Conclusions: These findings may promote more aggressive monitoring and earlier interventions for persistent hydrocephalus after intraventricular hemorrhage in patients at risk.

KW - External ventricular drainage

KW - Intraventricular hemorrhage

KW - Outcome

KW - Stroke

KW - Ventriculoperitoneal shunt

UR - http://www.scopus.com/inward/record.url?scp=85055465582&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055465582&partnerID=8YFLogxK

U2 - 10.1007/s12028-018-0532-x

DO - 10.1007/s12028-018-0532-x

M3 - Article

VL - 29

SP - 233

EP - 240

JO - Neurocritical Care

JF - Neurocritical Care

SN - 1541-6933

IS - 2

ER -