title: Determinants of external ventricular drain placement and associated outcomes in patients with spontaneous intraventricular hemorrhage.
abstract: BACKGROUND
  External ventricular drain (EVD) usage in patients with intraventricular hemorrhage (IVH) is variable in current practice and in clinical trials, and its impact on outcome remains controversial. The objective of this study was to identify the clinical predictors of EVD utilization, and associated outcome in adults with spontaneous IVH with or without intracerebral hemorrhage (ICH).
  
  
  METHODS
  Retrospective review of 183 consecutive IVH patients admitted to a University Hospital between 2003 and 2010. Clinical and radiographic data were analyzed for associations between EVD placement and mortality, poor outcome, and improvement in Glasgow Coma Scale score (GCS) using multivariate logistic regression models.
  
  
  RESULTS
  Average age was 62 ± 15.6 years, and average ICH and IVH volumes were 35.8 ± 40.9 cc and 19.7 ± 25.3 cc, respectively. Independent predictors of EVD placement within first 5 days of admission were GCS ≤ 8 (OR 11.5; P < 0.001), Graeb score >5 (OR 4.6; P = 0.001), and non-lobar ICH ≤ 30 cc (OR 9.7; P < 0.001). Median GCS increased from 5 (IQR 3-7) 48 h post-EVD (P < 0.001). EVD placement was an independent predictor of reduced mortality (OR 0.31; P = 0.04) and modified Rankin score 0-3 (OR 15.7; P = 0.01) at hospital discharge. In patients with hydrocephalus on presentation, EVD was associated with reduced mortality for patients with GCS > 3 after controlling for ICH and IVH severity (OR 0.02; P = 0.01).
  
  
  CONCLUSIONS
  Patients with lower GCS, higher IVH severity, and lower ICH volume are more likely to have an EVD placed. EVD placement is associated with reduced mortality and improved short-term outcomes in patients with IVH after adjusting for known severity factors. EVD use should be protocolized in clinical trials of ICH management where IVH is included.
authors: Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Daniel B
authors: DB
authors: Herrick
authors: Natalie
authors: N
authors: Ullman
authors: Saman
authors: S
authors: Nekoovaght-Tak
authors: Daniel F
authors: DF
authors: Hanley
authors: Issam
authors: I
authors: Awad
authors: Shannon
authors: S
authors: LeDroux
authors: Carol B
authors: CB
authors: Thompson
authors: Wendy C
authors: WC
authors: Ziai
mesh_terms: D000367:Age Factors; D000368:Aged; D002543:Cerebral Hemorrhage / Q000150:complications / Q000601:surgery*; D002552:Cerebral Ventricles / Q000601:surgery*; D015331:Cohort Studies; D004322:Drainage / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome