Early EVD Insertion Improves Surgical Outcome in Traumatic Brain Injury

Traumatic brain injury (TBI) is a significant global public health problem, affecting an estimated 50 to 60 million people annually, with an associated global economic cost of approximately USD 400 billion per year. Although only about 10% of hospital presentations after TBI involve moderate-to-severe TBI (m-sTBI), defined by a Glasgow Coma Scale (GCS) score of 12 or less, this group experiences the highest individual burden of death and disability. External ventricular drain (EVD) insertion is a common therapeutic intervention used to manage intracranial hypertension and mitigate secondary brain injury. However, the optimal timing for EVD insertion in m-sTBI cases is unclear, and practices vary widely. A new study has now shown that early EVD insertion (within 24 hours post-injury) may lead to better long-term functional outcomes for patients with m-sTBI who require this procedure to control intracranial hypertension.

In the study, which was published recently in the Journal of Neurotrauma, researchers at Monash University (Melbourne, Australia) compared six-month neurological outcomes between patients with m-sTBI who received early EVD insertion versus those who received it later (more than 24 hours after injury). The findings indicated that late EVD insertion was linked to a higher risk of death or severe disability at six-month follow-up. By pooling data from multiple studies, the researchers demonstrated that early EVD insertion in patients with m-sTBI was associated with better six-month outcomes compared to late insertion. These promising results suggest new avenues for future research and could potentially influence the current management of these patients.

“Our study findings support the hypothesis that earlier EVD insertion may lead to improved functional neurological outcomes following m-sTBI and imply that earlier use of an EVD (within 24-hours) is likely to be more effective in the management of m-sTBI, as opposed to a later ‘rescue’ intervention,” stated the investigators.

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Monash University