Introduction: The epidemiology of ventriculostomy among pediatric patients at the United States population level has not been well described. We sought to quantify the use of ventriculostomy and identify indications among pediatric patients in the United States.
Methods: Using the Nationwide Inpatient Sample from 2001-2010, patients <=18 years of age undergoing ventriculostomy were identified using ICD-9 procedure code 02.2. The primary diagnosis associated with each procedure was identified and comparisons were made across age groups using standard descriptive methods; data were weighted to represent the US national population.
Results: A total of 46,073 patients underwent ventriculostomy from 2001-2010 of whom 58.2% were male; mean age was 79.5 days (SE 2.2) among infants and 9.6 years (SE 0.1) among patients from 1-18 years old and 91.6% of patients had healthcare insurance. Most procedures occurred in teaching hospitals (91.9%) and in urban locations (98.5%). Most patients were infants (29.0%), followed by 15-18 year-olds (19.7%). Concurrent shunt placement occurred among 25.8% of patients, most being abdominal (87.6%). The most common indication in infants was hereditary and degenerative hydrocephalus (19.9%); however, brain malignancies in 1-5 (21.0%), 5-10 (24.0%), and 10-14 year-olds (19.2%), and intracranial injury in 15-18 year-olds (45.5%) were more common. Infants remained hospitalized twice as long as 15-18 year-olds (26.0 days IQR 9.0; 74.0 vs. 13.0 days IQR 5.0; 25.0 respectively, p<0.01). Overall in-hospital mortality was 11.1%, with patients aged 15-18 years twice as likely to die vs. children under 5 years old (OR2.3, 95% CI 1.9; 2.6). Mortality was common among patients with cerebral edema (49.8%), cerebral arterial occlusion (36.2%) and traumatic subarachnoid/subdural hemorrhage (28.0%) (all p<0.001).
Conclusions: Pediatric ventriculostomies were most commonly performed in infants with hydrocephalus, in 1-14 year-olds with brain malignancies and in 15-18 year-olds with intracranial injury. Mortality was most common among patients with cerebral edema.
Patient Care: A descriptive epidemiology of ventriculostomy and ventricular shunt procedures in pediatric patients provides a basis for assessment and evaluation of this aspect of neurosurgery practice.
An understanding of the common indications for ventriculostomy in the pediatric population and the conditions that are associated with mortality may be of value in patient triage, and may also support quantification/estimation of aspects of risks associated with the procedure.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) To describe the epidemiology of ventriculostomy in the pediatric population with emphasis on patient demographics, hospitalization characteristics, indications, and patient outcome;
2) To identify common indications for ventriculostomy in pediatric patients in separate age categories including: infants (<1 year old), 1-5 year-olds, 10-14 year-olds, and 15-18 year-olds;
3) To describe overall mortality in separate age categories and identify the common conditions associated with increased risk of mortality in pediatric patients undergoing ventriculostomy.