Optimal Timing of External Ventricular Drainage after Severe Traumatic Brain Injury: A Systematic Review

Abstract

External ventricular drainage (EVD) may be used for therapeutic cerebrospinal fluid (CSF) drainage to control intracranial pressure (ICP) after traumatic brain injury (TBI). However, there is currently uncertainty regarding the optimal timing for EVD insertion. This study aims to compare patient outcomes for patients with early and late EVD insertion. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, MEDLINE/EMBASE/Scopus/Web of Science/Cochrane Central Register of Controlled Trials were searched for published literature involving at least 10 severe TBI (sTBI) patients from their inception date to December 2019. Outcomes assessed were mortality, functional outcome, ICP control, length of stay, therapy intensity level, and complications. Twenty-one studies comprising 4542 sTBI patients with an EVD were included; 19 of the studies included patients with an early EVD, and two studies had late EVD placements. The limited number of studies, small sample sizes, imbalance in baseline characteristics between the groups and poor methodological quality have limited the scope of our analysis. We present the descriptive statistics highlighting the current conflicting data and the overall lack of reliable research into the optimal timing of EVD. There is a clear need for high quality comparisons of early vs. late EVD insertion on patient outcomes in sTBI.

The Evolution of the Role of External Ventricular Drainage in Traumatic Brain Injury

“…The “when” of CSF drainage in TBI patients has not received much attention. A systematic review (unpublished data provided by the authors) investigating the optimal timing of external ventricular drainage identified a lack of studies with direct head-on comparison [87]. The uncontrolled nature of the single-arm studies in which the data were pooled from precluded any comparison, thus further high-quality evidence is crucial.…”

The pattern of hospital-community-home (HCH) nursing in tracheostomy patients with severe traumatic brain injury: is it feasible?

“…Severe traumatic brain injury (TBI) refers to severe injuries of the central nervous system such as skull fracture, brain contusion and laceration, and intracranial hematoma caused by various reasons [1]. It's been reported that the incidence of STBI ranks rst in the all types of trauma, accounting for 9% to 21% of trauma in all parts of the body, and the mortality is as high as 50% [2,3]. In recent years, with the improvement of trauma treatment and the development of intensive care medicine, the mortality of STBI has declined, but the quality of life and daily living ability of surviving TBI patients have declined signi cantly [4].…”

The pattern of hospital‐community‐home (HCH) nursing in tracheostomy patients with severe traumatic brain injury: Is it feasible?

“…Severe traumatic brain injury (TBI) refers to severe injuries of the central nervous system such as skull fracture, brain contusion and laceration, and intracranial hematoma caused by various reasons [1]. It's been reported that the incidence of STBI ranks rst in the all types of trauma, accounting for 9-21% of trauma in all parts of the body, and the mortality is as high as 50% [2,3]. In recent years, with the improvement of trauma treatment and the development of intensive care medicine, the mortality of STBI has declined, but the quality of life and daily living ability of surviving TBI patients have declined signi cantly [4].…”

“…1 It has been reported that the incidence of STBI ranks first in all types of trauma, accounting for 9%-21% of trauma in all parts of the body, and the mortality is as high as 50%. 2,3 In recent years, with the improvement of trauma treatment and the development of intensive care medicine, the mortality of STBI has declined, but the quality of life and daily living ability of surviving TBI patients have declined significantly. 4 Therefore, it is necessary to carry out long-term nursing…”