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

Abstract

Introduction: External ventricular drains (EVDs) are used in the management of spontaneous intraparenchymal haemorrhage (ICH) to divert cerebrospinal fluid and reduce intracranial pressure. Despite being a recognised treatment, there remains a lack of data on outcomes after surgery.

Methods: Data was collected for all EVDs inserted from 2010 to 2022 at a tertiary neurosurgery centre in Sydney. Baseline demographic, clinical and radiological parameters were identified. Multivariate logistical regression analyses were conducted to determine factors significantly associated with higher mortality.

Results: Out of 116 identified patients, 60 (51.7% of the cohort) died during the index admission. Increasing age and pre-operative Glasgow Coma Score (GCS) were independent predictors of mortality and higher modified Rankin Score on discharge, while haematoma volume and presence of Swirl sign were associated with higher modified Rankin Score on discharge.

Discussion: EVD insertion has long been performed in the setting of spontaneous ICH, particularly in the presence of intraventricular haemorrhage (IVH) and hydrocephalus. However, we have demonstrated a number of factors which have a high associated mortality risk even with surgical intervention. In particular, older patients with a lower GCS pre-operatively had a high rate of mortality.