title: External ventricular drain practice variations: results from a nationwide survey.
abstract: OBJECTIVE While guidelines exist for many neurosurgical procedures, external ventricular drain (EVD) insertion has yet to be standardized. The goal of this study was to survey the neurosurgical community and determine the most frequent EVD insertion practices. The hypothesis was that there would be no standard practices identified for EVD insertion or methods to avoid EVD-associated infections. METHODS The American Association of Neurological Surgeons membership database was queried for all eligible neurosurgeons. A 16-question, multiple-choice format survey was created and sent to 7217 recipients. The responses were collected electronically, and the descriptive results were tabulated. Data were analyzed using the chi-square test. RESULTS In total, 1143 respondents (15.8%) completed the survey, and 705 respondents (61.6%) reported tracking EVD infections at their institution. The most common self-reported infection rate ranged from 1% to 3% (56.1% of participants), and 19.7% of respondents reported a 0% infection rate. In total, 451 respondents (42.7%) indicated that their institution utilizes a formal protocol for EVD placement. If a respondent's institution had a protocol, only 258 respondents (36.1%) always complied with the protocol. Protocol utilization for EVD insertion was significantly more frequent among residents, in academic/hybrid centers, in ICU settings, and if the institution tracked EVD-associated infection rates (p < 0.05). A self-reported 0% infection rate was significantly more commonly associated with a higher level of training (e.g., attending physicians), private center settings, a clinician performing 6 to 10 EVD insertions within the previous 12 months, and prophylactic continuous antibiotic utilization (p < 0.05). CONCLUSIONS This survey demonstrated heterogeneity in the practices for EVD insertion. No standard practices have been proposed or adopted by the neurosurgical community for EVD insertion or complication avoidance. These results highlight the need for the nationwide standardization of technique and complication prevention measures.
authors.affiliation: Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Griffin R
authors.initials: GR
authors.lastname: Baum
authors.affiliation: Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Kristopher G
authors.initials: KG
authors.lastname: Hooten
authors.affiliation: Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Lockney
authors.affiliation: Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina; and.
authors.forename: Kyle M
authors.initials: KM
authors.lastname: Fargen
authors.affiliation: Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Nefize
authors.initials: N
authors.lastname: Turan
authors.affiliation: Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Pradilla
authors.affiliation: Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Gregory J A
authors.initials: GJA
authors.lastname: Murad
authors.affiliation: Department of Neurosurgery, Penn State University School of Medicine, Hershey, Pennsylvania.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Harbaugh
authors.affiliation: Department of Neurosurgery, Penn State University School of Medicine, Hershey, Pennsylvania.
authors.forename: Michael
authors.initials: M
authors.lastname: Glantz
mesh_terms: D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D019538:Health Care Surveys; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D015994:Incidence; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology; D014696:Ventriculostomy / Q000009:adverse effects / Q000379:methods*
keywords: CDC = Centers for Disease Control and Prevention; EVD = external ventricular drain; external ventricular drain; guidelines; hydrocephalus; infection control