External Ventricular Drain Placement Accuracy and Safety When Done by Midlevel Practitioners.

Publication/Presentation Date

1-1-2019

Abstract

BACKGROUND: External ventricular drains (EVDs) measure intracranial pressure, divert cerebrospinal fluid, and allow for orthotropic administration of pharmacologic agents. Currently, neurosurgeons and neurosurgery residents are the primary practitioners placing EVDs. Due to the urgency of neurosurgical pathologies and the lack of qualified residents at most hospitals, midlevel practitioner (MLP) placement of EVDs would be advantageous.

OBJECTIVE: To assess the accuracy and complication rates of MLP and neurosurgeon EVD placement.

METHODS: This was a retrospective cohort of all patients with an EVD placed between January 2012 and September 2016 at a level 1 trauma center. We compared safety and accuracy of EVD placement between neurosurgeons and MLPs.

RESULTS: MLP first attempted EVD placement in 238 patients and senior neurosurgeon first attempted EVD placement in 70 subjects. There was no significant difference between accuracy of placement within the ventricle (87.4% vs 90.0%, P = .5557), hemorrhage rate (5.9% vs 4.3%, P = .77), or infection rate (0.8% vs 1.4%, P = .5399) for placement attempted by an MLP compared with a neurosurgeon, respectively.

CONCLUSION: MLPs perform EVD placement safely with no significant difference in accuracy of placement or complication rates compared with placement by senior neurosurgeons. This may allow for earlier management of elevated intracranial pressure and access to care where previously unavailable; leading to improved patient outcomes.

Volume

84

Issue

1

First Page

235

Last Page

241

ISSN

1524-4040

Disciplines

Medicine and Health Sciences

PubMedID

29618119

Department(s)

Department of Surgery

Document Type

Article

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