Introduction: We aim to characterize the clinical predictors of ventriculoperitoneal shunt (VPS) placement in aneurysmal subarachnoid hemorrhage (aSAH) patients. There has been no clear consensus as to effective measures of predicting VPS placement in these patients.
Methods: We reviewed the clinical data of patients with aneurysmal subarachnoid hemorrhage (aSAH) who were treated at our institution between 2011-2013. We recorded patient demographics and clinical predictors including admission Glasgow Coma Scale (GCS), Hunt Hess score, and incidence of vasospasm requiring intra-arterial therapy.
Results: There were 177 patients admitted with subarachnoid hemorrhage between 2011-2013. Fifty-three of these were non-aneurysmal or had withdrawal of care/death and were excluded from our analyses. Twenty-one percent (n=26/124) of patients required VPS. Mean age was 57.69 +/- 13.73 for the VPS cohort and 55.61 +/- 15.05 for the non-VPS cohort. Mean admission GCS for the non-VPS placement cohort was 12.1 +/- 3.9 and mean admission GCS for patients who did not require VPS placement was 10.0 +/-4.9 [Mean Difference (MD): 2.1; Confidence Interval (CI): -3.93 to -0.25; P=0.026]. Mean admission Hunt Hess was 3.3 for the VPS cohort 3.3 and 2.7 for the non-VPS cohort [MD: 0.63; CI: 0.06 to 1.21; P= 0.032]. 53.8% (n=14/26) of VPS patients had moderate-severe vasospasm requiring intra-arterial intervention versus 11.2% (n=11/98) of non-VPS patients [Risk Ratio (RR): 4.80; CI: 2.48 to 9.29; P=<0.0001].
Conclusions: Lower admission GCS, higher admission Hunt Hess score, and vasospasm requiring intra-arterial intervention are positive predictors of VPS requirement in aSAH patients.
Patient Care: Clinicians will have the ability to better predict patients requiring permanent VPS placement, preventing any delays in treatment and allowing clinicians the ability to better prepare these patients
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Better predict with patients will require VPS placement, 2) Identify patients who may benefit from early VPS placement