External ventricular drainage response in poor grade aneurysmal subarachnoid hemorrhage: Effect on preoperative grading and prognosis

Evan R. Ransom, J. Mocco, Ricardo J Komotar, Deshdeepak Sahni, Jennifer Chang, David K. Hahn, Grace H. Kim, J. Michael Schmidt, Robert R. Sciacca, Stephan A. Mayer, E. Sander Connolly

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Introduction: The importance of preoperative response to external ventricular drainage (EVD) for treatment of acute hydrocephalus (HCP) following poor grade (Hunt & Hess grade IV or V) aneurysmal subarachnoid hemorrhage (aSAH) has not been clearly defined. The effect of EVD response on preoperative grade and prognosis is described. Methods: Fifty-nine poor grade patients had an EVD placed preoperatively and underwent definitive aneurysm treatment between September 1996 and March 2002. Patients improving ≥ one Hunt and Hess grade were considered responders. Case-control comparisons were completed for each responder, based on clinical grade; the pre-EVD grade and the post-EVD (response) grade were used to generate two independent control cohorts. Logistic regression was used to evaluate the relationship of 12-month modified Rankin disability score (mRS) to clinical grade. Results: Nineteen (32%) responders were identified, and were less likely Grade V (p < 0.05), and more often had smaller (<13 mm, p < 0.01) and posterior circulation (p < 0.03) aneurysms. The frequency of favorable outcome (mRS ≤ 3) was greater in responders than non-responders (68% vs. 28%, p < 0.001). Responders had a similar incidence of favorable outcome as response-grade controls (74%), and a higher incidence of favorable outcome than pre-EVD controls (47%). Regression analysis identified the post-EVD grade, but not the pre-EVD grade, as significantly predictive of long-term outcome (p < 0.04). Conclusion: Long-term outcomes in poor grade patients who improve after EVD placement are similar to patients with lower grade hemorrhages. When an EVD is placed preoperatively in a poor grade aSAH patient, the neurological status after EVD determines the clinical grade.

Original languageEnglish
Pages (from-to)174-180
Number of pages7
JournalNeurocritical Care
Volume6
Issue number3
DOIs
StatePublished - Jun 1 2007
Externally publishedYes

Fingerprint

Subarachnoid Hemorrhage
Drainage
Aneurysm
Incidence
Hydrocephalus
Logistic Models
Regression Analysis
Hemorrhage

Keywords

  • Acute hydrocephalus
  • Aneurysm
  • External ventricular drainage
  • Poor grade
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

External ventricular drainage response in poor grade aneurysmal subarachnoid hemorrhage : Effect on preoperative grading and prognosis. / Ransom, Evan R.; Mocco, J.; Komotar, Ricardo J; Sahni, Deshdeepak; Chang, Jennifer; Hahn, David K.; Kim, Grace H.; Schmidt, J. Michael; Sciacca, Robert R.; Mayer, Stephan A.; Connolly, E. Sander.

In: Neurocritical Care, Vol. 6, No. 3, 01.06.2007, p. 174-180.

Research output: Contribution to journalArticle

Ransom, ER, Mocco, J, Komotar, RJ, Sahni, D, Chang, J, Hahn, DK, Kim, GH, Schmidt, JM, Sciacca, RR, Mayer, SA & Connolly, ES 2007, 'External ventricular drainage response in poor grade aneurysmal subarachnoid hemorrhage: Effect on preoperative grading and prognosis', Neurocritical Care, vol. 6, no. 3, pp. 174-180. https://doi.org/10.1007/s12028-007-0019-7
Ransom, Evan R. ; Mocco, J. ; Komotar, Ricardo J ; Sahni, Deshdeepak ; Chang, Jennifer ; Hahn, David K. ; Kim, Grace H. ; Schmidt, J. Michael ; Sciacca, Robert R. ; Mayer, Stephan A. ; Connolly, E. Sander. / External ventricular drainage response in poor grade aneurysmal subarachnoid hemorrhage : Effect on preoperative grading and prognosis. In: Neurocritical Care. 2007 ; Vol. 6, No. 3. pp. 174-180.
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abstract = "Introduction: The importance of preoperative response to external ventricular drainage (EVD) for treatment of acute hydrocephalus (HCP) following poor grade (Hunt & Hess grade IV or V) aneurysmal subarachnoid hemorrhage (aSAH) has not been clearly defined. The effect of EVD response on preoperative grade and prognosis is described. Methods: Fifty-nine poor grade patients had an EVD placed preoperatively and underwent definitive aneurysm treatment between September 1996 and March 2002. Patients improving ≥ one Hunt and Hess grade were considered responders. Case-control comparisons were completed for each responder, based on clinical grade; the pre-EVD grade and the post-EVD (response) grade were used to generate two independent control cohorts. Logistic regression was used to evaluate the relationship of 12-month modified Rankin disability score (mRS) to clinical grade. Results: Nineteen (32{\%}) responders were identified, and were less likely Grade V (p < 0.05), and more often had smaller (<13 mm, p < 0.01) and posterior circulation (p < 0.03) aneurysms. The frequency of favorable outcome (mRS ≤ 3) was greater in responders than non-responders (68{\%} vs. 28{\%}, p < 0.001). Responders had a similar incidence of favorable outcome as response-grade controls (74{\%}), and a higher incidence of favorable outcome than pre-EVD controls (47{\%}). Regression analysis identified the post-EVD grade, but not the pre-EVD grade, as significantly predictive of long-term outcome (p < 0.04). Conclusion: Long-term outcomes in poor grade patients who improve after EVD placement are similar to patients with lower grade hemorrhages. When an EVD is placed preoperatively in a poor grade aSAH patient, the neurological status after EVD determines the clinical grade.",
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T1 - External ventricular drainage response in poor grade aneurysmal subarachnoid hemorrhage

T2 - Effect on preoperative grading and prognosis

AU - Ransom, Evan R.

AU - Mocco, J.

AU - Komotar, Ricardo J

AU - Sahni, Deshdeepak

AU - Chang, Jennifer

AU - Hahn, David K.

AU - Kim, Grace H.

AU - Schmidt, J. Michael

AU - Sciacca, Robert R.

AU - Mayer, Stephan A.

AU - Connolly, E. Sander

PY - 2007/6/1

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N2 - Introduction: The importance of preoperative response to external ventricular drainage (EVD) for treatment of acute hydrocephalus (HCP) following poor grade (Hunt & Hess grade IV or V) aneurysmal subarachnoid hemorrhage (aSAH) has not been clearly defined. The effect of EVD response on preoperative grade and prognosis is described. Methods: Fifty-nine poor grade patients had an EVD placed preoperatively and underwent definitive aneurysm treatment between September 1996 and March 2002. Patients improving ≥ one Hunt and Hess grade were considered responders. Case-control comparisons were completed for each responder, based on clinical grade; the pre-EVD grade and the post-EVD (response) grade were used to generate two independent control cohorts. Logistic regression was used to evaluate the relationship of 12-month modified Rankin disability score (mRS) to clinical grade. Results: Nineteen (32%) responders were identified, and were less likely Grade V (p < 0.05), and more often had smaller (<13 mm, p < 0.01) and posterior circulation (p < 0.03) aneurysms. The frequency of favorable outcome (mRS ≤ 3) was greater in responders than non-responders (68% vs. 28%, p < 0.001). Responders had a similar incidence of favorable outcome as response-grade controls (74%), and a higher incidence of favorable outcome than pre-EVD controls (47%). Regression analysis identified the post-EVD grade, but not the pre-EVD grade, as significantly predictive of long-term outcome (p < 0.04). Conclusion: Long-term outcomes in poor grade patients who improve after EVD placement are similar to patients with lower grade hemorrhages. When an EVD is placed preoperatively in a poor grade aSAH patient, the neurological status after EVD determines the clinical grade.

AB - Introduction: The importance of preoperative response to external ventricular drainage (EVD) for treatment of acute hydrocephalus (HCP) following poor grade (Hunt & Hess grade IV or V) aneurysmal subarachnoid hemorrhage (aSAH) has not been clearly defined. The effect of EVD response on preoperative grade and prognosis is described. Methods: Fifty-nine poor grade patients had an EVD placed preoperatively and underwent definitive aneurysm treatment between September 1996 and March 2002. Patients improving ≥ one Hunt and Hess grade were considered responders. Case-control comparisons were completed for each responder, based on clinical grade; the pre-EVD grade and the post-EVD (response) grade were used to generate two independent control cohorts. Logistic regression was used to evaluate the relationship of 12-month modified Rankin disability score (mRS) to clinical grade. Results: Nineteen (32%) responders were identified, and were less likely Grade V (p < 0.05), and more often had smaller (<13 mm, p < 0.01) and posterior circulation (p < 0.03) aneurysms. The frequency of favorable outcome (mRS ≤ 3) was greater in responders than non-responders (68% vs. 28%, p < 0.001). Responders had a similar incidence of favorable outcome as response-grade controls (74%), and a higher incidence of favorable outcome than pre-EVD controls (47%). Regression analysis identified the post-EVD grade, but not the pre-EVD grade, as significantly predictive of long-term outcome (p < 0.04). Conclusion: Long-term outcomes in poor grade patients who improve after EVD placement are similar to patients with lower grade hemorrhages. When an EVD is placed preoperatively in a poor grade aSAH patient, the neurological status after EVD determines the clinical grade.

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KW - External ventricular drainage

KW - Poor grade

KW - Subarachnoid hemorrhage

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