Complication during postacute rehabilitation: patients with posttraumatic hydrocephalus

The objective of this study was to determine the incidence of posttraumatic hydrocephalus (PTH) among patients in our rehabilitation unit for traumatic brain injury. Furthermore, we aimed to assess the effect of shunt implantation and to identify the postoperative complication rate. This is a retrospective cohort study, in which between 2000 and 2009, data were collected from inpatients with traumatic brain injury complicated by PTH. During this period, 55 patients in our unit presented with PTH; all of these patients underwent ventricular shunt implantation. The incidence of PTH treated with shunt implantation was 4.8%. The mean age of the patients was 32 years (range 14-75 years). In 22 cases, the hydrocephalus was diagnosed in our rehabilitation unit (40%). Other patients were diagnosed and shunted before being transferred to our department. The median time of shunting was 80 days (range 20-270 days) after brain trauma. On the basis of scores of the functional independence measure, improvement could be observed in 43 cases (78%), the mean score improvement was 40 (2-81). Postoperative complications were seen in 10 patients (18%): four due to infections and six due to shunt failure. Revision was necessary in all 10 cases. Almost half of the diagnoses of PTH were established in the postacute rehabilitation unit, and all complications after shunt implantation were also recognized there. Precise clinical observation is necessary for diagnosis of PTH. Early diagnosis and treatment are important to prevent secondary complications. Teamwork and good cooperation between acute and postacute care are necessary for successful rehabilitation of patients with traumatic brain injury.