Extraventricular Drain May Not Improve Outcomes in Patients With Intracranial Haemorrhage: Presented at ANA

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Title: Extraventricular Drain May Not Improve Outcomes in Patients With Intracranial Haemorrhage: Presented at ANA
URL: http://www.pslgroup.com/dg/22D72A.htm
Doctor's Guide
September 24, 2008

By Andrew N. Wilner, MD

SALT LAKE CITY, Utah -- September 24, 2008 -- Placement of an extraventricular drain (EVD) in patients with intracranial haemorrhage (ICH) and intraventricular haemorrhage results in longer length of stay in hospital, longer stay in the intensive care unit (ICU), higher infection rate, lower Glasgow Coma Scale scores at discharge, and higher Modified Rankin Scale scores compared with similar patients without an EVD.

Ahmad Bayrlee, MD, Temple University School of Medicine, Philadelphia, Pennsylvania, presented the results of a study in patients with ICH at a poster session on September 22 here at the American Neurological Association (ANA) 133rd Annual Meeting.

Dr. Bayrlee explained that ICH is a catastrophic condition with a high mortality rate and poor functional outcome. EVDs are typically placed when a patient has hydrocephalus, blockage of the 3rd or 4th ventricle, or increased intracranial pressure. However, the criteria for drain insertion are not clearly defined.

In this retrospective study, 317 charts from a neurology ICU from November 2005 to November 2007 were reviewed and 213 patients with primary hypertensive haemorrhage were identified. The analysis excluded patients with ICH due to ruptured aneurysms, arteriovenous malformations, tumours, or infratentorial and haemorrhagic infarcts.

Thirty-five patients with primary hypertensive haemorrhage and EVDs were matched to patients with similar size haemorrhages, age, sex, and admission Glasgow Coma Scale score.

Patients with EVDs had longer median hospital length of stay versus the group without drains (31 vs 13 days; P = .02). Length of stay in the ICU was longer for the EVD group compared with the group without drains (30 vs 7 days; P = .003).

Infection rate was higher in the EVD group compared with the group without drains (81.3% vs 43.8%; P = .002).

Glasgow Coma Scale score at discharge was 11 in the EVD group and 13 in the group without drains (P = NS). In addition, the Modified Rankin Scale score was 5 in the EVD group and 4 in the group without drains (P = NS).

Dr. Bayrlee acknowledged that the groups may not have been perfectly matched, as it is not clear why some patients received EVDs and others did not. He emphasised that one cannot conclude that EVDs should not be used in patients with hypertensive ICH and intraventricular haemorrhage, however, the results highlight the need for further study of the indications for EVDs.

"It is difficult to study this problem with a randomised clinical trial, because the illness is sudden and severe, making informed consent difficult," he said. "In addition, the study cannot be blinded because of the invasive nature of the drain."

"Nonetheless," he added, "we need to further define the criteria for the placement of extraventricular drains. We will look at a scoring system that may help identify patients who are good candidates for extraventricular drains," Dr. Bayrlee concluded.

[Presentation title: The Impact of External Ventricular Drain (EVD) Placement in the Treatment of Supratentorial Hemorrhage With Intraventricular Extension. Abstract M-45]

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