title: External ventricular drain placement in the intensive care unit versus operating room: evaluation of complications and accuracy.
abstract: OBJECTIVE
  External ventricular drain (EVD) placement is a common neurosurgical procedure performed in both the intensive care unit (ICU) and operating room (OR). The optimal setting for EVD placement in regard to safety and accuracy of placement is poorly defined.
  
  
  METHODS
  A retrospective chart review was performed on 150 consecutive patients who underwent EVD placement at a tertiary care center from January of 2013 to February of 2014. Clinical and radiographic data were obtained and used to compare safety and accuracy of placement between EVDs placed in the ICU versus OR.
  
  
  RESULTS
  One hundred and thirty eight patients were evaluated. Complications (hemorrhage, infection, non-functional drain) occurred in 21.5% of ICU placements and 6.7% of OR placements (p = 0.028). Grade 1, 2, and 3 placements occurred in 67.7%, 25.8%, and 6.5% of ICU placements, respectively, versus 55.6%, 42.2%, and 2.2% of OR placements (p = 0.258). No patient who received pre-placement antibiotics suffered a ventriculostomy associated infection (VAI).
  
  
  CONCLUSIONS
  Patients who underwent ventriculostomy placement in the ICU differed in important ways (i.e. indication for placement and the administration of pre-procedure prophylactic antibiotics) from patients treated in the OR. However, the available data suggests that complications of hemorrhage, infection, and non-functional drains may be mitigated by ventriculostomy placement in the OR.
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Foreman
authors.affiliation: Department of Neurosurgery, Saarland University Hospital, Homburg/Saar, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Hendrix
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, USA.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, USA.
authors.forename: Philip G R
authors.initials: PG
authors.lastname: Schmalz
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, USA. Electronic address: mharrigan@uabmc.edu.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Harrigan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000009:adverse effects* / Q000592:standards; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000592:standards / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000009:adverse effects* / Q000592:standards; D055815:Young Adult
keywords: Complications; External ventricular drain; Intensive care unit; Operating room; Ventriculostomy