Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia.
Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida.
J Neurosurg. 2017 Nov;127(5):1190-1197. doi: 10.3171/2016.9.JNS16367. Epub 2017 Jan 13.
OBJECTIVE While guidelines exist for many neurosurgical procedures, external ventricular drain (EVD) insertion has yet to be standardized. The goal of this study was to survey the neurosurgical community and determine the most frequent EVD insertion practices. The hypothesis was that there would be no standard practices identified for EVD insertion or methods to avoid EVD-associated infections. METHODS The American Association of Neurological Surgeons membership database was queried for all eligible neurosurgeons. A 16-question, multiple-choice format survey was created and sent to 7217 recipients. The responses were collected electronically, and the descriptive results were tabulated. Data were analyzed using the chi-square test. RESULTS In total, 1143 respondents (15.8%) completed the survey, and 705 respondents (61.6%) reported tracking EVD infections at their institution. The most common self-reported infection rate ranged from 1% to 3% (56.1% of participants), and 19.7% of respondents reported a 0% infection rate. In total, 451 respondents (42.7%) indicated that their institution utilizes a formal protocol for EVD placement. If a respondent's institution had a protocol, only 258 respondents (36.1%) always complied with the protocol. Protocol utilization for EVD insertion was significantly more frequent among residents, in academic/hybrid centers, in ICU settings, and if the institution tracked EVD-associated infection rates (p < 0.05). A self-reported 0% infection rate was significantly more commonly associated with a higher level of training (e.g., attending physicians), private center settings, a clinician performing 6 to 10 EVD insertions within the previous 12 months, and prophylactic continuous antibiotic utilization (p < 0.05). CONCLUSIONS This survey demonstrated heterogeneity in the practices for EVD insertion. No standard practices have been proposed or adopted by the neurosurgical community for EVD insertion or complication avoidance. These results highlight the need for the nationwide standardization of technique and complication prevention measures.
尽管有许多神经外科手术的指南，但外部脑室引流 (EVD) 的插入尚未标准化。本研究的目的是调查神经外科学界，确定最常见的 EVD 插入实践。假设在 EVD 插入或避免 EVD 相关感染的方法方面没有标准做法。
在全美神经外科学会会员数据库中查询所有符合条件的神经外科医生。创建了一个 16 个问题的多项选择格式的调查，并发送给 7217 名收件人。通过电子方式收集回复，并对描述性结果进行制表。使用卡方检验对数据进行分析。
共有 1143 名受访者（15.8%）完成了调查，705 名受访者（61.6%）报告在其机构中跟踪 EVD 感染情况。最常见的自我报告感染率在 1%至 3%之间（56.1%的参与者），19.7%的受访者报告感染率为 0%。共有 451 名受访者（42.7%）表示其机构使用 EVD 放置的正式方案。如果受访者的机构有方案，只有 258 名受访者（36.1%）始终遵守方案。在居民、学术/混合中心、重症监护病房环境中，如果机构跟踪 EVD 相关感染率，EVD 插入方案的使用更为频繁（p<0.05）。自我报告的 0%感染率与更高水平的培训（例如主治医生）、私立中心环境、在过去 12 个月内进行 6 至 10 次 EVD 插入的临床医生以及预防性连续使用抗生素显著相关（p<0.05）。
本调查显示 EVD 插入实践存在异质性。神经外科学界尚未提出或采用 EVD 插入或并发症预防的标准做法。这些结果突出表明需要在全国范围内标准化技术和并发症预防措施。
