External ventricular drains and mortality in patients with severe traumatic brain injury

Can J Neurol Sci. 2010 Jan;37(1):43-8. doi: 10.1017/s031716710000963x.

Abstract

Purpose: 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.

Materials & methods: 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.

Results: 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).

Conclusions: 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.

MeSH terms

  • Adult
  • Brain Injuries / mortality*
  • Brain Injuries / surgery*
  • Cohort Studies
  • Drainage* / adverse effects
  • Female
  • Hospital Mortality*
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Male
  • Middle Aged
  • Propensity Score
  • Retrospective Studies
  • Treatment Outcome