Identifying Factors Associated With a Poor Outcome Following External Ventricular Drain Insertion for Spontaneous...

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• External ventricular drains (EVDs) are utilized to manage spontaneous intraparenchymal hemorrhage (ICH) by diverting cerebrospinal fluid and reducing intracranial pressure.
• Despite EVDs being a recognized treatment for ICH, comprehensive outcome data post-intervention remains limited.

Purpose of the Study:

• To investigate the outcomes of patients undergoing EVD insertion for spontaneous ICH.
• To identify factors associated with mortality and functional outcomes in this patient cohort.

Main Methods:

• A retrospective analysis of 116 patients who underwent EVD insertion for spontaneous ICH between 2010 and 2022 at a tertiary neurosurgery center.
• Multivariate logistic regression analyses were employed to identify predictors of mortality and functional outcomes (modified Rankin Score).

Main Results:

• Mortality during the index admission was 51.7% (60 out of 116 patients).
• Increasing age and lower preoperative Glasgow Coma Score (GCS) were independent predictors of mortality.
• Hematoma volume and the presence of a Swirl sign were associated with higher modified Rankin Scores on discharge, indicating poorer functional outcomes.

Conclusions:

• EVD insertion is a common procedure for spontaneous ICH, especially with intraventricular hemorrhage or hydrocephalus.
• Factors such as advanced age and low preoperative GCS are associated with high mortality risk despite surgical intervention.
• Identifying these risk factors can aid in patient management and prognostication for spontaneous ICH treated with EVDs.