Efficacy and Predictors of Success of External Ventricular Drainage for The Management of Traumatic Intracranial Hypertension: A Retrospective Multicenter Cohort Study

Background External ventricular drainage (EVD) is commonly used to manage elevated intracranial pressure (ICP) following traumatic brain injury (TBI). However, evidence supporting its effectiveness in this context remains limited. This study aimed to evaluate the effectiveness of EVD in controlling elevated ICP and to identify clinical and radiological factors associated with its success. Methods A multicenter retrospective cohort study was conducted between 1st January 2019 and 31 December 2022 across nine regional trauma centers in France participating in the Traumabase. All TBI patients with intracranial hypertension despite maximal medical therapy and treated with EVD were included. EVD success was defined as an efficient control of ICP avoiding the use of any third-tier therapy or avoiding a decision to withdraw life-sustaining treatment due to both refractory intracranial hypertension and severity of brain injury lesions. Results A cohort of 176 TBI patients with EVD was constituted. Among them, 88 patients (50%) had sustained control of intracranial pressure after EVD. In multivariate analysis, sedation with a combination of sedative drugs (OR 0.28; 95% CI 0.12–0.62, p = 0.002), obliterated cisternal basal on the brain CT scan prior to EVD placement (OR 0.07; 95% CI 0.00-0.39, p = 0.013) and severity of chest trauma (OR 0.79; 95% CI 0.64–0.99, p = 0.039) were factors associated with poor likelihood of EVD success. Conversely, EVD placement occurring more than 24 hours after admission was independently associated with success (OR 3.07; 95% CI 1.41–7.01, p  = 0.006). Conclusion In this multicenter cohort of TBI patients with refractory ICH, EVD effectively controlled intracranial pressure in half of the cases. The effectiveness of EVD appears to depend on the severity and the rapidity of onset of traumatic intracranial hypertension.