External Ventricular Drains and Mortality in Patients with Severe Traumatic Brain Injury

To determine our institutional adherence to the Brain Trauma Foundation guidelines with respect to intracranial pressure (ICP) monitoring, and examine the relationship between external ventricular drain (EVD) use and mortality. Retrospective cohort study of 171 patients with severe traumatic brain i...

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Bibliographic Details
Published in:Canadian journal of neurological sciences 2010-01, Vol.37 (1), p.43-48
Main Authors: Griesdale, Donald E. G., McEwen, Jonathan, Kurth, Tobias, Chittock, Dean R.
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Brain Injuries - mortality
Brain Injuries - surgery
Cohort Studies
Drainage - adverse effects
Female
Hospital Mortality
Humans
Injuries of the nervous system and the skull. Diseases due to physical agents
Intensive Care Units - statistics & numerical data
Male
Medical sciences
Middle Aged
Neurology
Propensity Score
Retrospective Studies
Traumas. Diseases due to physical agents
Treatment Outcome
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Summary:To determine our institutional adherence to the Brain Trauma Foundation guidelines with respect to intracranial pressure (ICP) monitoring, and examine the relationship between external ventricular drain (EVD) use and mortality. Retrospective cohort study of 171 patients with severe traumatic brain injury (TBI). Propensity score adjusted logistic regression was used to model the association between EVD use and mortality. EVDs were inserted in 98 of 171 patients. Of the 73 patients without an EVD, 63 (86%) would have qualified for ICP monitoring under the current guidelines. EVDs were in situ for a median of 8 days (SD 6). In adjusted analyses, EVD use was associated with hospital mortality (OR 2.8, 95% CI: 1.1 - 7.1, p = 0.04) and 28-day mortality (OR 2.1, 95% CI: 0.80 - 5.6, p = 0.13). We observed significant modification of the association between EVD and 28-day mortality by GCS within 12 hours (p-interaction = 0.04), indicating strong association only among those patients with GCS score of at least 6 (OR 5.0, 95% CI: 1.5 - 16.7, p < 0.01). The association of EVD with 28-day mortality was only apparent among patients with GCS score of > or = 6. Further research is warranted to further refine which patients may benefit from ICP monitoring.
ISSN:0317-1671
2057-0155
DOI:10.1017/S031716710000963X