Long-term outcomes after shunt implantation in patients with posttraumatic hydrocephalus and severe conscious disturbance.

BACKGROUND: Posttraumatic hydrocephalus (PTH) is a frequent complication secondary to traumatic brain injury, especially among patients keeping chronic unconscious. And effects of shunt implantation on improving outcomes among these patients are still controversial. This study was aimed to assess the long-term outcomes following shunt implantation among patients who had PTH and kept chronic unconscious. METHODS: A prospective study was performed to include patients who had PTH and remained in severe conscious disturbance from March 2010 to December 2010. All of included patients would have shunt implantation and be closely followed up at least for 2 years to assess final outcomes. RESULTS: Fifteen patients having PTH were identified. Before shunt implantation, 2 patients kept vegetative state (Glasgow Outcome Scale [GOS] score 2), and 13 patients kept minimally consciousness with severe disability (GOS score 3). After shunt implantation, the shunt device was removed because of intracranial infection in 1 patient, and the other patient died because of allergic shock. Among the remaining 13 patients, finally 7 patients had improvement on GOS or Modified Barthel Index (MBI) score during the 2-year follow-up, but only 1 patient achieved a good outcome (GOS score 4, independent life). Among them, 5 patients' outcomes improved as assessed by GOS or MBI score during the first 3 months following shunt implantation. During the fourth to sixth month following shunt implantation, there were 2 patients who showed first rise on GOS or MBI score. Beyond 6 months, no patient showed initial improvement. And among patients who showed improvement, most of them kept improving during a certain time. CONCLUSIONS: A proportion of patients who had PTH and remained in severe conscious disturbance would benefit from shunt implantation, and the improvement may turn up late after this procedure.

Violent head trauma in China: report of 2254 cases.

BACKGROUND: The occurrence of violent trauma has recently increased, and it has become both a social and medical problem in China. We are the first to explore violent head trauma in China. METHODS: Patients with violent head trauma were taken from all hospitalized patients with head trauma from January 2001 to December 2006 admitted to 11 hospitals in China. The rate, causes, age, sex, injury severity (GCS score), CT findings, management, outcome, and complications of patients with violent head trauma were retrospectively analyzed. RESULTS: Two thousand two hundred fifty-four (9.46%) patients with violent head trauma were found among a total of 23816 hospitalized patients with head trauma at 11 hospitals. Violent head trauma was caused by blunt objects (n = 1260, 55.90%), sharp/cutting instruments (n = 271, 12.02%), gunshots (n = 10, 0.44%), and others (n = 713, 31.63%). Violent head trauma was more likely to be found men (n = 1890, 83.85%) and in persons aged 21 to 40 years (n = 1216, 53.95%). In 2254 patients with violent head trauma, scalpel injury was seen in 1277 cases, skull fracture in 786 cases, cerebral contusion in 285 cases, and intracranial hematomas in 898 cases. Five hundred eighty-nine (26.13%) patients had body violent trauma besides violent head trauma. A GCS score of 13 to 15 was found in 1869 (82.92%) patients, 9 to 12 in 166 (7.36%), and 8 or less in 219 (9.72%). One thousand forty-two patients got surgical treatment, and another 1212 received medical management. One thousand nine hundred thirty-one (85.67%) patients had good recovery, 141 (6.47%) had moderate deficits, 36 (1.65%) had severe deficits, 7 (0.32%) had PVS, 63 (2.89%) died, and for the other 76, records were lost. CONCLUSIONS: Violent head trauma is certainly both a social and medical problem now, which indicates that violence should be controlled and that the human right of social safety needs to be improved in China.