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

Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital and University of Cambridge, Cambridge CB2 0QQ, UK
Faculty of Medicine, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
Medical Research Council Biostatistics Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SR, UK
Neurosurgical Trials Group, Newcastle University, Newcastle upon Tyne NE4 5PLE, UK
Department of Neurosurgery, Innsbruck Medical University, 6020 Innsbruck, Austria
Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
Department of Neurology, Division of Neurosurgery, University of São Paulo, São Paulo 01246-903, Brazil
NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge CB2 0QQ, UK
Surgery Theme, Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(6), 1996;
Received: 27 May 2020 / Revised: 17 June 2020 / Accepted: 22 June 2020 / Published: 25 June 2020
(This article belongs to the Special Issue Traumatic Brain Injury: Recent Developments and Emerging Trends)
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. View Full-Text
Keywords: neurosurgery; ventriculostomy; neurotrauma; intracranial pressure; EVD; TBI; ICP neurosurgery; ventriculostomy; neurotrauma; intracranial pressure; EVD; TBI; ICP
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Chau, C.Y.C.; Mediratta, S.; McKie, M.A.; Gregson, B.; Tulu, S.; Ercole, A.; Solla, D.J.F.; Paiva, W.S.; Hutchinson, P.J.; Kolias, A.G. Optimal Timing of External Ventricular Drainage after Severe Traumatic Brain Injury: A Systematic Review. J. Clin. Med. 2020, 9, 1996.

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