Neurocritical Care

, Volume 21, Issue 3, pp 426–434 | Cite as

Determinants of External Ventricular Drain Placement and Associated Outcomes in Patients with Spontaneous Intraventricular Hemorrhage

  • Daniel B. Herrick
  • Natalie Ullman
  • Saman Nekoovaght-Tak
  • Daniel F. Hanley
  • Issam Awad
  • Shannon LeDroux
  • Carol B. Thompson
  • Wendy C. Ziai
Original Article



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.


External ventricular drain Intracerebral hemorrhage Tissue plasminogen activator Stroke Cerebrovascular disease 


Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Daniel B. Herrick
    • 1
  • Natalie Ullman
    • 1
  • Saman Nekoovaght-Tak
    • 1
  • Daniel F. Hanley
    • 1
  • Issam Awad
    • 3
  • Shannon LeDroux
    • 2
  • Carol B. Thompson
    • 4
  • Wendy C. Ziai
    • 2
  1. 1.Division of Brain Injury OutcomesJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Johns Hopkins Hospital, Division of Neurosciences Critical Care, Department of NeurologyJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Section of Neurosurgery and the Neurovascular Surgery ProgramUniversity of Chicago Pritzker School of MedicineChicagoUSA
  4. 4.The Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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