Prevalence of hydrocephalus in the patients with traumatic brain injury: A systematic review and meta-analysis

BACKGROUND: The purpose of this study was determination of the prevalence of post-traumatic hydrocephalus (PTH) in patients who had traumatic brain injury (TBI) worldwide. METHODS: Four electronic databases including Scopus, PubMed, Embase, and Web of Science were searched in this meta-analysis. The random-effects model was applied for the pooled effect size of I2 > 50%. Subgroup analysis was done to evaluate the heterogeneity, and the Egger's test was used to test the asymmetry of the funnel plots in order to assess the publication bias. RESULTS: A total of 48 studies with 11624 patients were evaluated. The pooled prevalence of PTH was 13% [95% confidence interval (CI): 11.0-15.0] and according to decompressive craniectomy (DC) surgery was 22.0% (95% CI: 18.0-26.0). This result among patients with severe TBI (sTBI) was 16.0% (95% CI: 13.0-19.0) and it was higher in the developed countries. The prevalence of PTH was generally higher in studies with a sample size lower than 100 (21.0%) and was generally lower in studies conducted between 1990 to1999 (4.0%). These results were not too different according to the study design. CONCLUSION: It is recommended to design a prospective clinical study in order to explain the true dynamics and circulation of the cerebrospinal fluid (CSF) after DC. Moreover, there is a need to evaluate the cost-effectiveness of DC in reducing the intracranial pressure in comparison with other available options. In fact, performing the clinical studies with higher quality in less developed countries could provide more reliable related results to achieve a true global conclusion.