Mortality in pediatric hydrocephalus.
Hannah M Tully, Dan Doherty, Mark Wainwright
PMID 34268734WHAT IT FOUND
In children with hydrocephalus, death is more often caused by other medical conditions than by the hydrocephalus itself.
When hydrocephalus did cause death, half the cases involved catastrophic shunt failure, while others followed decisions to withhold surgery based on perceived poor neurodevelopmental outcomes.
Key findings
01Most deaths in the cohort were due to comorbidities rather than elevated intracranial pressure.
02Of the deaths directly related to hydrocephalus, half were due to shunt complications and the other half were influenced by decisions not to treat or to withdraw care.
03Surgical treatment was associated with a reduced risk of death overall, though temporary drains alone were associated with higher risk.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was retrospective, relying on existing medical records which may not capture all nuances of family-clinician discussions. The cohort was drawn from a tertiary medical center, which may bias results toward more severely affected patients. Loss to follow-up due to patients moving from the region could not be fully accounted for. The study could not determine what outcomes might have been achieved had all children received maximal medical support.
Declared interests
The study was funded by the National Institutes of Health. The Clinical Data Repository was developed by Research Informatics and Genospace and funded by Seattle Children’s Research Institute.
The easy way to misread this
Do not interpret the association between non-treatment and death as evidence that withholding surgery is generally harmful; the study indicates these decisions were often made in the context of severe congenital anomalies or perceived poor neurodevelopmental potential, where the benefit of surgery was judged to be low.