Management of External Ventricular Drains for Neuromonitoring and Traumatic Brain Injury Treatment in Pediatric Patients Outside of Intensive Care Units: A Single-Institution Retrospective Study.

Abstract

Background: Most pediatric hospitals manage patients who require external ventricular drains (EVDs) exclusively within pediatric intensive care units (PICUs) because of institutional protocols. Our institution commonly manages patients with EVDs on the neurotrauma floor (NTF). We evaluated whether this practice results in more EVD-associated complications.

Methods: A retrospective cohort study at our Level 1 pediatric trauma center identified all trauma patients ≤18 years old who received an EVD in 2018-2023. Demographics, presenting characteristics, in-hospital management, and EVD management details were recorded. The primary outcome was EVD-related complication events.

Results: Of the 81 patients who had EVDs placed after neurotrauma, 45 had their EVD managed exclusively in the PICU (PICU-EVD) and 36 had their EVD for some time while on the NTF (NTF-EVD). The groups were similar in sex (p = 0.87) and age (p = 0.054). PICU-EVD patients underwent fewer neurosurgeries (55.6% vs. 77.8%, p = 0.04) but spent more time on ventilators (10.6 ± 8.7 days vs. 6.4 ± 4.8, p = 0.02) and in the PICU (11.8 ± 9.0 days vs. 8.4 ± 5.9, p = 0.02). Total hospital stay was similar between groups (p = 0.44). NTF-EVD patients were on the drain longer (9.0 ± 7.4 days vs. 13.1 ± 9.1, p = 0.03), including 5.9 days on the NTF. Four EVD-related complications occurred overall: 2 accidental dislodgements and 2 cerebrospinal fluid leaks. EVD complication rates were similar on the NTF and PICU (2.2% vs. 8.3%, p = 0.21). All complications occurred late in the hospital course and were minor. A Poisson regression model comparing complication rates between PICU-only and NTF management (433 vs. 441 catheter days, respectively) found a complication rate of 6.8 per 1000 catheter days in the NTF group versus 2.3 per 1000 catheter days in the PICU-only group, yielding a rate ratio of 2.95 (95% confidence interval 0.29-30.4, p = 0.35). However, this difference was not statistically significant.

Conclusion: Our center routinely discharges patients from the PICU to the NTF with EVDs in place. This practice may be associated with no increased risk or rate of EVD-related complications compared to PICU-only management.

Level of evidence: IV.