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Updated: Jun 16, 2026
A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
External ventricular drains and mortality in patients with severe traumatic brain injury
Donald E G Griesdale1, Jonathan McEwen, Tobias Kurth
1Department of Anesthesiology, University of British Columbia & Program of Critical Care Medicine, Vancouver General Hospital, Vancouver BC, Canada.
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.
