Hydrocephalus-related quality of life as assessed by children and their caregivers

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  • 1 Department of Neurosurgery, Division of Pediatric Neurosurgery,
  • 3 Department of Ophthalmology, and
  • 4 Department of Biostatistics, University of Alabama at Birmingham, Alabama; and
  • 2 School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
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OBJECTIVE

Hydrocephalus is a chronic medical condition that has a significant impact on children and their caregivers. The objective of this study was to measure the quality of life (QOL) of children with hydrocephalus, as assessed by both caregivers and patients.

METHODS

Pediatric patients with hydrocephalus and their caregivers were enrolled during routine neurosurgery clinic visits. The Hydrocephalus Outcomes Questionnaire (HOQ), a report of hydrocephalus-related QOL, was administered to both children with hydrocephalus (self-report) and their caregivers (proxy report about the child). Patients with hydrocephalus also completed measures of anxiety, depression, fatigue, traumatic stress, and headache. Caregivers completed a proxy report of child traumatic stress and a measure of caregiver burden. Demographic information was collected from administration of the Psychosocial Assessment Tool (version 2.0) and from the medical record. Child and caregiver HOQ scores were analyzed and correlated with clinical, demographic, and psychological variables.

RESULTS

The mean overall HOQ score (parent assessment of child QOL) was 0.68. HOQ Physical Health, Social-Emotional Health, and Cognitive Health subscore averages were 0.69, 0.73, and 0.54, respectively. The mean overall child self-assessment (cHOQ) score was 0.77, with cHOQ Physical Health, Social-Emotional Health, and Cognitive Health subscore means of 0.84, 0.79, and 0.66, respectively. Thirty-nine dyads were analyzed, in which both a child with hydrocephalus and his or her caregiver completed the cHOQ and HOQ. There was a positive correlation between parent and child scores (p < 0.004 for all subscores). Child scores were consistently higher than parent scores. Variables that showed association with caregiver-assessed QOL in at least one domain included child age, etiology of hydrocephalus, and history of endoscopic third ventriculostomy. There was a significant negative relationship (rho −0.48 to −0.60) between child-reported cHOQ score and child-reported measures of posttraumatic stress, anxiety, depression, and fatigue. There was a similar significant relationship between caregiver report of child’s QOL (HOQ) and caregiver assessment of the child’s posttraumatic stress symptoms as well as their assessment of burden of care (rho = −0.59 and rho = −0.51, respectively). No relationship between parent-reported HOQ and child-reported psychosocial factors was significant. No clinical or demographic variables were associated with child self-assessed cHOQ.

CONCLUSIONS

Pediatric patients with hydrocephalus consistently rate their own QOL higher than their caregivers do. Psychological factors such as anxiety and posttraumatic stress may be associated with lower QOL. These findings warrant further exploration.

ABBREVIATIONS ASC-Kids = Acute Stress Checklist for Kids; cHOQ = children’s HOQ; CSDC = Child Stress Disorders Checklist; ETV = endoscopic third ventriculostomy; EVD = external ventricular drain; HCRN = Hydrocephalus Clinical Research Network; HOQ = Hydrocephalus Outcomes Questionnaire; PAT = Psychosocial Assessment Tool; PedMIDAS = Pediatric Migraine Disability Assessment; PROMIS = Patient-Reported Outcomes Measurement Information System; PTSS = posttraumatic stress symptoms; QOL = quality of life; VP = ventriculoperitoneal.

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Contributor Notes

Correspondence Brandon G. Rocque: University of Alabama at Birmingham, AL. brandon.rocque@childrensal.org.

INCLUDE WHEN CITING Published online July 10, 2020; DOI: 10.3171/2020.4.PEDS19660.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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