Introduction: The authors explored the change in vitals for patients with cerebral spinal fluid (CSF) infection post external ventricular drain (EVD) placement and compared these vitals to those of non-infected EVD placed patients.
Methods: A list of 346 patients was first identified with an EVD placed between January 2011 and October 2015 at a university medical center in the Southwest region. This was then reduced to 144 after excluding subjects without CSF cultures. Although patients may have had pre-existing conditions leading to abnormal vitals, there was an equal random chance for this occurring in both study groups, nullifying any differences.
Results: We found an infection rate of 7.63% with 11 confirmed CSF infections occurring on the day of or after the placement of the EVD. In 54% of the infections Staphylococcus Aureus was the identified pathogen. Infections were, on average, discovered 4.73 days post-EVD placement. After comparing the vitals between the two groups using logistic regression (excluding 5 previously infected subjects), no difference was seen in heart rate (HR) (P=.951), temperature (P=.974), or systolic (P=.744) and diastolic (P=.811) blood pressure. A significant difference was found in the white blood cell count (WBC) (OR 1.26, p =.006). Respiratory rate (RR) was significant as well but found to be attributable to the larger portion of infants in the infected study group than non-infected group, and was considered not unique to CSF infections.
Conclusions: Clinicians are encouraged to use a rise in the WBC as a predictor for CSF infection in patients with EVDs. Given the relative high degree of perturbed vitals in patients requiring EVD placement, this may not always be reliable. However, elevation in this vital may prompt the clinician to order CSF cultures sooner than the assigned routine culture regimen.
Patient Care: This research will help improve patient care by providing physicians with a predictor for patients with a CSF infection who have an external ventricular drain placed.
Learning Objectives: By the conclusion of this session, participants should be able to 1.) Describe the importance of early recognition of CSF infection in patients with EVD placement 2.) Discuss in small groups possible indicators of CSF infection in these patients 3.) Identify an effective way to use elevated WBCs as way to improve early recognition of CSF infection
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