title: Prediction of ventriculoperitoneal shunt placement based on type of failure during external ventricular drain wean.
abstract: OBJECTIVE
  There are multiple etiologies for failure while weaning an external ventricular drain (EVD) after subarachnoid hemorrhage (SAH), but there is little data on the relationship between etiology of wean failure and ventriculoperitoneal shunt (VPS) placement.
  
  
  METHODS
  We performed a retrospective analysis of SAH patients who had an EVD placed between January 2008 and June 2012 at our institution. For each wean step (defined as raising or clamping the EVD), we recorded success or failure. We categorized failure as lowering or opening the EVD due to elevated intracranial pressure (ICP), clinical failure (due to headache or vomiting or altered mental status), leakage from the EVD site, or development of radiographic hydrocephalus. We evaluated the relationship between etiology of wean failure and subsequent need for VPS.
  
  
  RESULTS
  Of 116 patients with an EVD placed, 35 required VPS placement (30%). Patients who required VPS placement had a median of 2 (interquartile range (IQR) 1-4) wean failures and those who did not require VPS placement had a median of 1 (IQR 0-1) wean failure (p=0.001). There was no significant relationship between age, sex, Hunt Hess score, Fisher score, Glasgow coma scale, aneurysm location, aneurysm size, aneurysm treatment method, vasospasm and need for VPS. There was a significant relationship between patients with at least one wean failure due to clinical changes or radiographic hydrocephalus and need for VPS (p=0.007 and p=0.029, respectively). After multivariate analysis, there was only a significant relationship between clinical changes and need for VPS (OR 2.76, CI 1.03-7.36, p=0.04).
  
  
  CONCLUSIONS
  There is a significant association between wean failure due to clinical changes and requirement for VPS placement after SAH.
authors.affiliation: Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, USA. Electronic address: Ariane.kansas.lewis@gmail.com.
authors.forename: Ariane
authors.initials: A
authors.lastname: Lewis
authors.affiliation: Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, USA. Electronic address: wtkimberly@partners.org.
authors.forename: W
authors.initials: W
authors.lastname: Taylor Kimberly
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
keywords: Extraventricular drain; Hydrocephalus; Subarachnoid hemorrhage; Ventriculoperitoneal shunt
references.citation: Acta Neurochir Suppl. 2012;114:217-20
references.pmid: 22327696
references.citation: J Neurosurg. 2009 Nov;111(5):1029-35
references.pmid: 19361256
references.citation: World Neurosurg. 2011 Dec;76(6):548-54
references.pmid: 22251503
references.citation: BMC Surg. 2012 Jul 05;12:12
references.pmid: 22765765
references.citation: J Stroke Cerebrovasc Dis. 2012 Aug;21(6):493-7
references.pmid: 21236700
references.citation: J Neurosurg. 2004 Feb;100(2):225-9
references.pmid: 15086228
references.citation: Neurosurgery. 1981 Dec;9(6):686-91
references.pmid: 7322334
references.citation: Top Stroke Rehabil. 2009 Sep-Oct;16(5):330-8
references.pmid: 19903651
references.citation: J Korean Neurosurg Soc. 2010 Oct;48(4):313-8
references.pmid: 21113357
references.citation: J Korean Neurosurg Soc. 2008 Apr;43(4):177-81
references.pmid: 19096639
references.citation: Surg Neurol Int. 2011;2:117
references.pmid: 21918732
references.citation: Stroke. 1989 Jun;20(6):747-53
references.pmid: 2728040
references.citation: Neurosurgery. 1990 May;26(5):804-8; discussion 808-9
references.pmid: 2352599
references.citation: J Neurosurg. 1997 Mar;86(3):462-6
references.pmid: 9046303
references.citation: J Neurosurg. 2010 Oct;113(4):774-80
references.pmid: 20367072
references.citation: Neurosurgery. 2003 Apr;52(4):763-9; discussion 769-71
references.pmid: 12657171
references.citation: J Neurosurg. 2009 Jan;110(1):44-9
references.pmid: 18950263
references.citation: Neurosurgery. 2010 May;66(5):904-8; discussion 908-9
references.pmid: 20404694
references.citation: Neurosurgery. 2008 Mar;62(3):618-27; discussion 618-27
references.pmid: 18425009
references.citation: J Rehabil Med. 2009 Nov;41(13):1096-9
references.pmid: 19894008
references.citation: J Neurosurg. 2002 Nov;97(5):1042-4
references.pmid: 12452133