Herrick Daniel B, Ullman Natalie, Nekoovaght-Tak Saman, Hanley Daniel F, Awad Issam, LeDroux Shannon, Thompson Carol B, Ziai Wendy C
Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Neurocrit Care. 2014 Dec;21(3):426-34. doi: 10.1007/s12028-014-9959-x.
External ventricular drain (EVD) usage in patients with intraventricular hemorrhage (IVH) is variable in current practice and in clinical trials, and its impact on outcome remains controversial. The objective of this study was to identify the clinical predictors of EVD utilization, and associated outcome in adults with spontaneous IVH with or without intracerebral hemorrhage (ICH).
Retrospective review of 183 consecutive IVH patients admitted to a University Hospital between 2003 and 2010. Clinical and radiographic data were analyzed for associations between EVD placement and mortality, poor outcome, and improvement in Glasgow Coma Scale score (GCS) using multivariate logistic regression models.
Average age was 62 ± 15.6 years, and average ICH and IVH volumes were 35.8 ± 40.9 cc and 19.7 ± 25.3 cc, respectively. Independent predictors of EVD placement within first 5 days of admission were GCS ≤ 8 (OR 11.5; P < 0.001), Graeb score >5 (OR 4.6; P = 0.001), and non-lobar ICH ≤ 30 cc (OR 9.7; P < 0.001). Median GCS increased from 5 (IQR 3-7) 48 h post-EVD (P < 0.001). EVD placement was an independent predictor of reduced mortality (OR 0.31; P = 0.04) and modified Rankin score 0-3 (OR 15.7; P = 0.01) at hospital discharge. In patients with hydrocephalus on presentation, EVD was associated with reduced mortality for patients with GCS > 3 after controlling for ICH and IVH severity (OR 0.02; P = 0.01).
Patients with lower GCS, higher IVH severity, and lower ICH volume are more likely to have an EVD placed. EVD placement is associated with reduced mortality and improved short-term outcomes in patients with IVH after adjusting for known severity factors. EVD use should be protocolized in clinical trials of ICH management where IVH is included.
在当前临床实践和临床试验中，脑室内出血（IVH）患者使用外部脑室引流（EVD）的情况存在差异，其对预后的影响仍存在争议。本研究的目的是确定EVD使用的临床预测因素，以及伴有或不伴有脑出血（ICH）的自发性IVH成年患者的相关预后。
回顾性分析2003年至2010年间连续入住一所大学医院的183例IVH患者。使用多因素逻辑回归模型分析临床和影像学数据，以确定EVD置入与死亡率、不良预后以及格拉斯哥昏迷量表（GCS）评分改善之间的关联。
平均年龄为62±15.6岁，平均ICH和IVH体积分别为35.8±40.9立方厘米和19.7±25.3立方厘米。入院后前5天内EVD置入的独立预测因素为GCS≤8（比值比[OR]11.5；P<0.001）、格雷布评分>5（OR 4.6；P=0.001）和非叶性ICH≤30立方厘米（OR 9.7；P<0.001）。EVD置入后48小时，GCS中位数从5（四分位间距3-7）增加（P<0.001）。EVD置入是出院时死亡率降低（OR 0.31；P=0.04）和改良Rankin评分0-3（OR 15.7；P=0.01）的独立预测因素。在入院时患有脑积水的患者中，在控制ICH和IVH严重程度后，EVD与GCS>3的患者死亡率降低相关（OR 0.02；P=0.01）。
GCS较低、IVH严重程度较高且ICH体积较小的患者更有可能置入EVD。在调整已知严重程度因素后，EVD置入与IVH患者死亡率降低和短期预后改善相关。在包括IVH的ICH管理临床试验中，EVD的使用应规范化。
