External ventricular drains in pediatric patients

Area of Science:

• Neurosurgery
• Pediatric Critical Care

Background:

• External ventricular drains (EVDs) are crucial for managing intracranial pressure and cerebrospinal fluid diversion in pediatric neurosurgery.
• Indications and complication profiles of EVDs in pediatric populations require thorough investigation.

Purpose of the Study:

• To determine the primary indications for external ventricular drain (EVD) placement in pediatric patients.
• To identify and analyze the complications associated with EVD insertion in children.
• To compare complication rates based on diagnosis and insertion location.

Main Methods:

• Retrospective chart review of pediatric patients undergoing EVD placement.
• Data collected from a tertiary-level children's hospital between 1994 and 2006.
• Analysis of 96 EVD insertions in 66 pediatric patients.

Main Results:

• Primary indications included traumatic brain injury (36%), acute hydrocephalus (35%), and ventriculoperitoneal shunt failure (29%).
• Overall complication rate was 26%, with infection (9.4%) being the most common, often caused by coagulase-negative Staphylococcus.
• Complication rates were similar for EVDs placed for traumatic brain injury versus hydrocephalus, and for bedside (pediatric critical care unit) versus operating room insertions.

Conclusions:

• External ventricular drains are frequently indicated for traumatic brain injury, shunt failure, and hydrocephalus in pediatric patients.
• The overall complication rate of 26% highlights the need for careful management and monitoring.
• Insertion location (pediatric critical care unit vs. operating room) and primary diagnosis (TBI vs. hydrocephalus) did not significantly impact complication rates.
• Prophylactic strategies targeting coagulase-negative Staphylococcus, such as antibiotics or antimicrobial-impregnated catheters, may help reduce infection rates.