TY - JOUR
T1 - Quantitative Modeling of External Ventricular Drain Output to Predict Shunt Dependency in Aneurysmal Subarachnoid Hemorrhage
T2 - Cohort Study
AU - Perry, A.
AU - Graffeo, C. S.
AU - Kleinstern, G.
AU - Carlstrom, L. P.
AU - Link, M. J.
AU - Rabinstein, A. A.
N1 - Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Background: Acute hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH); however, attempts to predict shunt-dependent chronic hydrocephalus using clinical parameters have been equivocal. Methods: Cohort study of aSAH is treated with external ventricular drainage (EVD) placement at our institution, 2001–2016, via logistic regression. EVD-related parameters included mean/total EVD output (days 0–2), EVD days, EVD days ≤ 5 mmHg, and wean/clamp fails. aSAH outcomes assessed included ventriculoperitoneal shunt (VPS) placement, delayed cerebral ischemia (DCI), radiographic infarction (RI), symptomatic vasospasm (SV), age, and aSAH grades. Results: Two hundred and ten aSAH patients underwent EVD treatment for a median 12 days (range 1–54); 85 required VPS (40%). On univariate analysis, EVD output, total EVD days, EVD days ≤ 5 mmHg, and wean/clamp trial failures were significantly associated with VPS placement (p < 0.01 for all parameters). No EVD output parameter demonstrated a significant association with DCI, RI, or SV. On multivariate analysis, EVD output was a significant predictor of VPS placement, after adjusting for age and clinical and radiological grades; the optimal threshold for predicting VPS placement was mean daily output > 204 ml on days 0–2 (OR 2.59, 95% CI 1.31–5.07). Multiple wean failures were associated with unfavorable functional outcome, after adjusting for age, grade, and VPS placement (OR 1.65, 95% CI 1.10–2.47). We developed a score incorporating age, grade and EVD parameters (MAGE) for predicting VPS placement after aSAH. Conclusions: EVD output parameters and wean/clamp trial failures predicted shunt dependence in an age- and grade-adjusted multivariable model. Early VPS placement may be warranted in patients with MAGE score ≥ 4, particularly following 2 failed wean trials.
AB - Background: Acute hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH); however, attempts to predict shunt-dependent chronic hydrocephalus using clinical parameters have been equivocal. Methods: Cohort study of aSAH is treated with external ventricular drainage (EVD) placement at our institution, 2001–2016, via logistic regression. EVD-related parameters included mean/total EVD output (days 0–2), EVD days, EVD days ≤ 5 mmHg, and wean/clamp fails. aSAH outcomes assessed included ventriculoperitoneal shunt (VPS) placement, delayed cerebral ischemia (DCI), radiographic infarction (RI), symptomatic vasospasm (SV), age, and aSAH grades. Results: Two hundred and ten aSAH patients underwent EVD treatment for a median 12 days (range 1–54); 85 required VPS (40%). On univariate analysis, EVD output, total EVD days, EVD days ≤ 5 mmHg, and wean/clamp trial failures were significantly associated with VPS placement (p < 0.01 for all parameters). No EVD output parameter demonstrated a significant association with DCI, RI, or SV. On multivariate analysis, EVD output was a significant predictor of VPS placement, after adjusting for age and clinical and radiological grades; the optimal threshold for predicting VPS placement was mean daily output > 204 ml on days 0–2 (OR 2.59, 95% CI 1.31–5.07). Multiple wean failures were associated with unfavorable functional outcome, after adjusting for age, grade, and VPS placement (OR 1.65, 95% CI 1.10–2.47). We developed a score incorporating age, grade and EVD parameters (MAGE) for predicting VPS placement after aSAH. Conclusions: EVD output parameters and wean/clamp trial failures predicted shunt dependence in an age- and grade-adjusted multivariable model. Early VPS placement may be warranted in patients with MAGE score ≥ 4, particularly following 2 failed wean trials.
KW - External ventricular drain
KW - Hydrocephalus
KW - Logistic regression
KW - MAGE
KW - Predictive modeling
KW - Subarachnoid hemorrhage
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UR - http://www.scopus.com/inward/citedby.url?scp=85076754261&partnerID=8YFLogxK
U2 - 10.1007/s12028-019-00886-2
DO - 10.1007/s12028-019-00886-2
M3 - Article
C2 - 31820290
AN - SCOPUS:85076754261
SN - 1541-6933
VL - 33
SP - 218
EP - 229
JO - Neurocritical care
JF - Neurocritical care
IS - 1
ER -