Hello, my name is Harshit Tirala, and I am a third-year medical student presenting an abstract of the research participated at Montefiore Medical Center, appropriately named as, A Retrospective Quality Analysis of External Ventricular Drain Infection Rates Following Stroke Diagnoses and Other Brain Injuries, Comparison of Emergency Room and ICU or OR Setting. The primary objective of this study is to analyze the incidence of infections in patients following the placement of an external ventricular drain, otherwise known as EVD-related infections, abbreviated ERI. This comparison is between the placement of an EVD in the emergency room versus the placement of an EVD in the ICU or OR at a single comprehensive stroke center. Thus, the study compares the rates of ERIs considering the environment where the EVD was done under in a large sample of patients. There are also several secondary and tertiary aims within this specific study. The secondary aim is to assess if higher rates of ERIs are associated with stroke-related patients or non-stroke-related patients. The tertiary aim is to address if the rates of conversion of EVD to ventricular peritoneal shunts has any correlation with ERI rates. This study was conducted as a large retrospective analysis at a quaternary care center located in Bronx, New York. The study began with collecting retrospective clinical data from chart reviews of all the patients that had undergone EVD placement from January 2010 to June 2018, which consisted a total of 710 patients, inclusive of all ages and sex. Patients were first analyzed according to the primary objective of this study, which is to compare EVD placements based on location, specifically between the emergency room versus the ICU or OR EVD placement. Prior to July 2015, all patients that had an EVD placement were in the setting of an emergency room. In July 2015, however, the protocol for EVD placement had been modified to being placed in the ICU or in the OR only. Due to this modification, the ERI rates were then compared from patients prior to and after July 2015 to see the comparison between ERI rates in the ER setting versus ERI rates in the ICU or OR setting. According to the secondary aim of this study, data was also collected to compare the ERI rates between stroke and non-stroke related patients. Criteria for stroke and non-stroke related patients are listed here. Lastly, for the tertiary aim, we located all the patients that required a conversion of EVD to ventricular peritoneal shunts. The percentage of these specific patients that required the conversion were also observed whether they were diagnosed with an ERI. Chi-square and t-test statistical analyses were both performed to analyze categorical and continuous variables, respectively, using a standardized software program. A p-value of less than 0.05 was considered statistically significant. The first result displays that ERI rates decreased from 13% in the ER to 7.7% in the ICU or OR setting. This result answers the primary objective of this study as there is a statistically significant decrease in ERI rates following the shift in EVD placement from the ER to EVD placement in the ICU or OR setting. This next result signifies one of the secondary aims as the data illustrates that out of the two groups, non-stroke related patients have significantly higher rates of ERIs compared to stroke related patients. Lastly, these results display that nearly 22% of all the patients required a conversion from EVD to VPS placement. Out of these 22%, nearly 27% of these patients were diagnosed with an ERI. As for the remaining patients who did not require a conversion from EVD to VPS placement, only 6.7% of these patients were diagnosed with an ERI. This data addresses the tertiary aim mentioned in this study in that patients that required a conversion from EVD to VPS placement were more likely to be diagnosed with an ERI than those that did not require the conversion. In conclusion, it is notable to state that this is one of the larger retrospective studies conducted on EVD related infections, which has illustrated that EVD placement setting is significant overall. More specifically, ERI rates proved to be statistically greater when EVDs were placed in the emergency room. The study also displays that non-stroke related patients have statistically higher rates of ERIs compared to stroke related patients. Additionally, the results of this study highlight that those that required a conversion from EVD to VPS placement were statistically more likely to be diagnosed with an ERI. Overall, these results highlight the importance of focusing on EVD related infection rates and the implications CSF infections have on the long-term care of patients. Here are all the references for this study. Thank you for your attention and for your time.

infections

external ventricular drain

EVD

ICU

patient care