Related Experiment Video

Updated: May 12, 2026

Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
09:01

Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Published on: October 15, 2021

A 7-Point Risk Stratification Tool for EVD Placement in Acute Intracerebral Hemorrhage: A Multivariable Analysis and

Mohsin Fayaz1, Farhaan Parvaiz Bhat1, Sarabjit Singh Chibber1

  • 1Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.

Asian Journal of Neurosurgery
|May 11, 2026
PubMed

Insights

A new EVD-ICH score helps predict the need for external ventricular drain (EVD) insertion in patients with intracerebral hemorrhage (ICH). This bedside tool uses clinical and radiological factors to stratify risk, aiding treatment decisions.

Area of Science:

  • Neurosurgery
  • Neurology
  • Critical Care Medicine

Background:

  • Intracerebral hemorrhage (ICH) presents significant morbidity and mortality risks.
  • Intraventricular extension (IVE) and hydrocephalus (HCP) often necessitate external ventricular drain (EVD) placement.
  • Current guidelines lack objective criteria for EVD use in ICH patients.

Purpose of the Study:

  • To identify clinical and radiological predictors of EVD insertion in spontaneous ICH.
  • To develop a simple bedside scoring system, the EVD-ICH score, for decision support.
  • To improve objective criteria for EVD management in ICH.

Main Methods:

  • Prospective observational study of 100 adult spontaneous ICH patients.
  • Collection of clinical and CT scan variables.
  • Multivariable logistic regression and ROC analysis for predictor identification and score validation.

Main Results:

  • Key predictors for EVD insertion included IVE, HCP, Glasgow Coma Scale (GCS) ≤ 8, hematoma volume ≥30 mL, and hypertension history.
  • The 7-point EVD-ICH score demonstrated an AUC of 0.85 (95% CI: 0.78-0.92).
  • An optimal cutoff of ≥3 provided 80% sensitivity and 77% specificity for predicting EVD need.

Conclusions:

  • The EVD-ICH score offers a practical bedside tool for risk stratification in spontaneous ICH.
  • The score predicts EVD probability from 8% to 92% based on score values.
  • Further external validation and outcome assessment are recommended before widespread adoption.
Abstract

Keywords:
Glasgow coma scalehydrocephalusintraventricular hemorrhagerisk assessmentscoring system

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