Does the Setting of External Ventricular Drain Placement Affect Morbidity? A Systematic Literature Review Comparing...

Area of Science:

• Neurosurgery
• Critical Care Medicine
• Medical Device Technology

Background:

• External ventricular drains (EVDs) are crucial for managing intracranial pressure.
• EVD placement can occur in the neurosurgical intensive care unit (ICU) or operating room (OR).
• Current evidence comparing EVD placement settings is limited and lacks standardization.

Purpose of the Study:

• To systematically review and analyze the literature comparing EVD placement in the ICU versus the OR.
• To assess differences in catheter placement accuracy, hemorrhagic complications, and infection rates.
• To identify the need for standardized outcome metrics for evidence synthesis.

Main Methods:

• Systematic review of PubMed database (inception to December 12, 2019) adhering to PRISMA guidelines.
• Inclusion of 9 studies from 356 initially identified articles.
• Categorization of studies into OR-only, ICU-only, and combined OR+ICU cohorts for comparative analysis.

Main Results:

• Catheter placement accuracy was higher in the OR (84.25%) compared to the ICU (68.29%).
• Iatrogenic hemorrhagic complication rates were similar between OR (17.50%) and ICU (18.16%) settings.
• Ventriculostomy-related infection rates were comparable: OR (8.06%) versus ICU (7.28%).

Conclusions:

• The optimal setting for EVD placement (ICU vs. OR) remains debated due to inconclusive evidence.
• Variability in study methodologies and outcome reporting hinders definitive recommendations.
• Standardized data collection and reporting are essential to generate high-quality evidence for clinical practice guidelines.