Association Between Early External Ventricular Drain Insertion and Functional Outcomes 6 Months Following...

Area of Science:

• Neurosurgery
• Neurocritical Care
• Trauma Surgery

Background:

• Traumatic brain injury (TBI) is a significant cause of death and disability worldwide.
• Intracranial hypertension is a critical secondary injury in moderate-to-severe TBI (m-sTBI) and a key therapeutic target.
• External ventricular drains (EVDs) are used to manage intracranial pressure, but optimal timing for insertion remains unclear.

Purpose of the Study:

• To investigate the association between the timing of EVD insertion and functional neurological outcomes at 6 months post-m-sTBI.
• To address practice variations in EVD placement timing for m-sTBI patients.
• To analyze pooled data from major TBI research initiatives.

Main Methods:

• Pooled individual patient data from EPO-TBI, POLAR, CENTER-TBI, and Oz-ENTER studies.
• Included patients with m-sTBI (Glasgow Coma Scale ≤12) aged ≥15 years, requiring EVD within 7 days of injury.
• Used hierarchical multi-variable logistic regression to compare early (≤24h) vs. late (>24h) EVD insertion and 6-month Glasgow Outcome Score Extended (GOSE).

Main Results:

• 2536 patients were analyzed; 20% received early EVD and 6% received late EVD.
• Late EVD insertion was associated with significantly higher odds of death or severe disability (GOSE 1-4) at 6 months (aOR: 2.14; 95% CI: 1.22-3.76; p=0.008).
• Adjustments were made for IMPACT score, sex, injury severity, study, and treatment site.

Conclusions:

• Early EVD insertion (within 24 hours) in m-sTBI patients requiring this intervention may lead to improved long-term functional outcomes.
• These findings support the need for further prospective research on optimal EVD timing in TBI management.
• Timely EVD placement is crucial for mitigating secondary brain injury and improving patient prognosis.