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Area of Science:

  • Neurosurgery
  • Medical Practice
  • Patient Safety

Background:

  • External ventricular drains (EVDs) are crucial for monitoring intracranial pressure and managing cerebrospinal fluid.
  • Currently, neurosurgeons primarily perform EVD placement, but limitations exist due to urgent cases and resident availability.
  • Midlevel practitioners (MLPs) could offer a valuable solution for timely EVD insertion.

Purpose of the Study:

  • To evaluate the safety and accuracy of EVD placement by MLPs compared to neurosurgeons.
  • To assess complication rates, including hemorrhage and infection, associated with MLP versus neurosurgeon EVD placement.

Main Methods:

  • A retrospective cohort study was conducted on patients who underwent EVD placement between January 2012 and September 2016.
  • Data from a level 1 trauma center were analyzed to compare the accuracy and safety outcomes of EVD placement by MLPs and neurosurgeons.

Main Results:

  • MLPs initiated EVD placement in 238 patients, while senior neurosurgeons initiated in 70.
  • No significant differences were observed in the accuracy of ventricular placement (87.4% vs. 90.0%), hemorrhage rates (5.9% vs. 4.3%), or infection rates (0.8% vs. 1.4%) between MLP and neurosurgeon groups.

Conclusions:

  • MLP EVD placement is as safe and accurate as that performed by senior neurosurgeons.
  • This finding supports the expanded role of MLPs in managing intracranial pressure, potentially improving patient outcomes and access to care.