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Published on: October 14, 2022
Paediatric External Ventricular Drains: Experience from a tertiary care hospital of a Developing Country
Abbas Qalab1, Rayaan Asad2, Mahnaz Hakeem1
1Department of Pediatrics and Child Health, Aga Khan University, Karachi.
Insights
External ventricular drain (EVD) placement in children aged 1 month to 16 years showed acute hydrocephalus as the primary indication. EVD infections were the most frequent complication, highlighting the need for careful management in pediatric neurosurgery.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Infectious Diseases
Background:
- External ventricular drains (EVDs) are crucial for managing pediatric hydrocephalus and intracranial pressure.
- Understanding indications and complications is vital for optimizing patient outcomes.
Purpose of the Study:
- To describe the indications for and complications of EVD placement in children aged 1 month to 16 years.
- To analyze patient demographics, diagnoses, and outcomes at a tertiary care hospital.
Main Methods:
- Retrospective chart review of 177 pediatric patients who underwent EVD placement between January 2007 and December 2014.
- Data collected included patient demographics, diagnoses, indications for EVD, and observed complications.
Main Results:
- Acute hydrocephalus (secondary to infection, tumor, or hemorrhage) was the leading indication for EVD (64%).
- Complications occurred in 26% of patients, with infections (14.1%) being the most common, often caused by Staphylococcus.
- Mortality rate was 14%, with acute hydrocephalus and EVD infection being significant factors.
Conclusions:
- EVD placement is essential for pediatric acute hydrocephalus, but carries a significant risk of complications, particularly infection.
- Improved infection control strategies and vigilant monitoring are necessary to reduce morbidity and mortality associated with EVDs in children.
Abstract:
The aim of the study was to describe indications and complications of external ventricular drain (EVD) placement in children aged between 1 month and 16 years. This retrospective chart review was conducted at the Aga Khan University Hospital, Karachi, and comprised all children who underwent EVD placement from January 2007 to December 2014. Of the 177 patients identified, 117(66%) were males 60(34%) were girls. The overall mean age was 5.4±5.2 years. The median Glasgow Coma Scale score on presentation and discharge was 13 (interquartile range [IQR]: 7) and 15 (IQR: 4), respectively. Major diagnosis included intracranial tumour 60(34%), bacterial meningitis 34(19%), tuberculous meningitis 33(18.6%), and haemorrhage 23(13%). Clinical indications for EVD insertion were acute hydrocephalus secondary to infection 64(36.2%), tumour 54(30.5%), and haemorrhage 23(13%) ventriculoperitoneal shunt malfunction or infection 25(14.1%) and traumatic brain injury 11(6.2%). Complications were observed in 47(26%) patients including infections 25(14.1%), malfunction 11(6.2%), haemorrhage 6(3.4%), misplacement 3(1.7%) and obstruction 2(1.1%). Staphylococcus was the main organism isolated. Moreover, 25(14%) patients expired. Acute hydrocephalus was the major indication and EVD infection was the major complication.
