Highlights
- •The prognosis of patients with ventriculostomy related infection is poorly defined.
- •We found no increase in mortality in patients with ventriculostomy infections.
- •We found no evidence of worse functional neurological outcome.
- •Patients with ventriculostomy infection have increased use of healthcare resources.
Abstract
Background
Ventriculostomy – related infection (VRI) is a common complication of patients who
require placement of an external ventricular drain (EVD). The clinical outcomes of
people who are diagnosed with VRI is poorly characterised. We performed a systematic
review and meta-analysis to assess the association between VRI, and clinical outcomes
and resource use, in patients treated with an EVD.
Methods
We searched MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of clinical
trials to identify clinical trial and cohort studies that reported outcomes including
mortality, functional outcome, duration of EVD insertion, and intensive care and hospital
length of stay. Inclusion criteria and data extraction were conducted in duplicate.
Where sufficient data were available, data synthesis was conducted using a random
effects model to provide a pooled estimate of the association between VRI and clinical
outcomes and resource use. We also pooled data to provide an estimate of the incidence
of VRI in this population.
Results
Nineteen studies including 38,247 patients were included in the meta-analysis. There
were twelve different definitions of VRI in the included studies. The pooled estimate
of the incidence of VRI was 11 % (95 % confidence interval (CI), 9 % to 14 %). A diagnosis
of VRI was not associated with an increase in the estimated odds ratio (OR) for mortality
(OR 1.07, 95 % CI 0.59 to 1.92, p = 0.83 I2 = 83.5 %), nor was a diagnosis of VRI associated with changes in neurological outcome
(OR 1.42, 95 % CI 0.36 to 5.56, p = 0.89, I2 = 0.3 %). Those diagnosed with VRI had longer intensive care unit length of stay
(estimated pooled mean difference 8.4 days 95 % CI 3.4 to 13.4 days, p = 0.0009, I2 = 78.7 %) an increase in hospital length of stay (estimated mean difference 16.4 days.
95 % CI 11.6 to 21.2 days, p < 0.0005, I2 = 76.6 %), a prolonged duration of EVD placement (mean difference 5.24 days, 95 %
CI 3.05 to 7.43, I2 = 78.2 %, p < 0.01), and an increased requirement for an internal ventricular shunt
(OR 1.80, 95 % CI 1.32 to 2.46, I2 = 8.92 %, p < 0.01).
Conclusions
Ventriculostomy related infection is not associated with increased mortality or an
increased risk of poor neurological outcome, but is associated with prolonged duration
of EVD placement, prolonged duration of ICU and hospital admission, and an increased
rate of internal ventricular shunt placement.
Abbreviations:
CNS (Central Nervous System), CSF (Cerebrospinal fluid), EVD (External Ventricular Drain), GOS (Glasgow Outcome Scale), LOS (Length of Stay), mRS (modified Rankin Scale), NOS (Newcastle Ottawa Scale), RoB2 (Revised Cochrane Risk of Bias scale), VRI (Ventriculostomy-related infection)Keywords
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Article info
Publication history
Accepted:
February 7,
2023
Received:
August 18,
2022
Identification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
