Introduction: Spontaneous intracerebral hemorrhage (ICH), commonly presents with intraventricular hemorrhage (IVH) and remains one of the most disabling forms of stroke. Extraventricular drains (EVDs) are associated with decreased IVH mortality, but their indications for utilization and outcomes benefit remain undefined. The purpose of this study was to determine the impact of EVD utilization on mortality and functional outcomes after ICH.
Methods: A bi-institutional retrospective analysis of 553 patients with spontaneous ICH from 2010-2013 was performed using multivariate regression modeling. Primary outcomes were mortality and functional status with Modified Rankin Score (mRS). A stratified propensity analysis was performed to control for differences in patient and clinical characteristics influencing EVD utilization, including: age, sex, GCS, ICH location and volume, IVH presence, mGraeb Score, and ICH score. Patients were further stratified based on predicted probability of EVD utilization (Low Prob<0.25, Moderate Prob 0.25-0.5, and High Prob>0.5).
Results: Propensity analysis modeling showed odds of EVD utilization increased with basal ganglia involvement, increased IVH volume, and concurrent IVH, while utilization decreased with age and extensive ICH volume; excellent discriminability for EVD utilization was demonstrated (AUROC 0.88, R2McFadden = 0.35). EVD utilization was associated with decreased odds of mortality (Moderate OR = 0.7, High OR = 0.6) as the probability of EVD utilization increased; however, significance was not reached (Table 1). Among survivors, mRS at discharge was significantly higher in patients receiving an EVD in the lower EVD risk strata (4.0 vs. 5.0, p=0.006), but not different in the highest EVD risk strata.
Conclusions: Among a large bi-institutional cohort, the statistical propensity analysis model was able to accurately predict EVD utilization in ICH. There was an overall trend towards decreased mortality associated with EVD utilization as probability for EVD increased. EVD utilization was associated with significantly higher mRS for functional outcomes.
Patient Care: Understanding the positive impact of EVD utilization on mortality and functional outcomes even on high-grade ICH patients can guide decision making and patient/family counseling
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Understand the impact of EVD utilization on ICH patient outcomes 2) Counsel patients and families on the impact of EVD utilization on mortality after ICH
3) Discuss the impact of IVH co-presentation on mortality and outcomes in ICH patients