Infection Incidence Associated with External Ventriculostomy Placement: A Comparison of Outcomes in the Emergency Department, Intensive Care Unit, and Operating Room

Background: External ventricular drain (EVD) placement is a common neurosurgical procedure used to control acute hydrocephalus and other neurosurgical complications. The infection and complication rates reported in the literature are highly variable, and iatrogenic factors determine the outcome of drain placement. We examined the impact of the setting of EVD placement (emergency department [ED] vs. intensive care unit [ICU] vs. operating room [OR]) and the experience of the operating surgeon on the infection rate, complication rate, EVD replacement, eventual placement of a ventriculoperitoneal shunt, and the need for further surgical intervention.

Methods: This was a retrospective, single-center study conducted at University Hospital in Newark, New Jersey.

Results: A total of 190 EVDs were placed in 163 patients. The infection rate was 6.13%, and the complication rate was 12.3%. Six out of the 10 patients with infection had the EVD placed in the ICU, but this was not significant (P = 0.1172). Patients with a Glasgow Outcome Scale score of 1 or 2 (dead or vegetative) after the procedure were significantly more likely to have an EVD placed in the ED or ICU (P = 0.0173). Although junior residents placed a greater number of drains than senior residents, the infection and complication rates were not significantly different between the 2 groups (P = 0.1142 and 0.8502, respectively). EVD infection also was not significantly correlated with patient sex, age, initial diagnosis, drain replacement, or duration of drain placement. The most common organisms cultured were coagulase-negative Staphylococcus spp. and Staphylococcus aureus.

Conclusions: This study did not identify any significantly greater risk of infection or complications with EVDs placed in the OR or at the bedside, or with EVDs placed by less-experienced surgeons.