The Incidence of Meningitis in Patients with Traumatic Brain Injury Undergoing External Ventricular Drain Placement: A Nationwide Inpatient Sample Analysis
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Infection is the most common complication of external ventricular drain (EVD) placement. National trends in the annual incidence of meningitis among patients with traumatic brain injury (TBI) who have undergone EVD placement have not been reported.
The Nationwide Inpatient Sample was used to select adults with a primary diagnosis of TBI who underwent EVD placement between 2002 and 2011. Annual rates of meningitis among patients who underwent EVD placement were determined. We also calculated mortality rates and length of stay (LOS). Potential factors associated with meningitis were evaluated in a binary logistic regression analysis.
Out of 1,571,927 adult discharges with a primary diagnosis of TBI between 2002 and 2011, 39,029 (2.5%) underwent EVD placement. Of these, 1544 (4.3%) patients developed meningitis. There was no significant trend in the annual incidence of meningitis (p = 0.88), mortality (p = 0.55), or mean LOS (p = 0.13) during the study period. Meningitis and mortality rates remained stable when stratifying patients by hospital volume. In the binary logistic regression, acquired immunodeficiency syndrome, sepsis, and cerebrospinal fluid leak were associated with meningitis.
The incidence of meningitis in patients who underwent EVD placement remained stable between 2002 and 2011. Further prospective studies are needed to identify approaches for preventing these infections.
KeywordsTraumatic brain injury Ventriculostomy Cross-infection
HH conceptualized the study, analyzed the data, edited the manuscript, and created the tables and figures. MSJ reviewed the literature, drafted the manuscript, and approved the final version of the manuscript. LSC oversaw the project, provided guidance in each phase of the study (study design, data interpretation, drafting of the manuscript), critically reviewed the manuscript, and approved the final version of the manuscript.
Source of Support
No funding was received for this work.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 12.Baram D, Daroowalla F, Garcia R, et al. Use of the all patient refined-diagnosis related group (APR-DRG) risk of mortality score as a severity adjustor in the medical ICU. Clin Med Circ Respir Pulm Med. 2008;18:19–25.Google Scholar
- 18.Guyot LL, Dowling C, Diaz FG, Michael DB. Cerebral monitoring devices: analysis of complications. Acta Neurochir. 1998;71:47–9.Google Scholar
- 24.Keong NC, Bulters DO, Richards HK, et al. The SILVER (Silver Impregnated Line Versus EVD Randomized trial): a double-blind, prospective, randomized, controlled trial of an intervention to reduce the rate of external ventricular drain infection. Neurosurgery. 2012;71:394–403 (discussion 403–4).CrossRefPubMedGoogle Scholar
- 38.Luerssen TG, Chesnut RM, Van Berkum-Clark M, et al. Post traumatic cerebrospinal fluid infections in the Traumatic Coma Data Bank: the influence of the type and management of ICP monitors. In: The 8th international symposium on intracranial pressure. Rotterdam: Springer; 1991.Google Scholar
- 41.Carney N, Totten AM, O’Reilly C, et al. Guidelines for the management of severe traumatic brain injury. Neurosurgery. 2017;80:6–15.Google Scholar