External Ventricular Drains versus Intraparenchymal Intracranial Pressure Monitors in XXXX : A Prospective Observational Study.

@entity1 @entity131 @entity101 @entity428
BACKGROUND: @entity428 ( @entity428 ) monitoring is the standard of care for @entity1 with @entity131 ( @entity131 ) and is used frequently. However, the efficacy of treatment based on the type of @entity428 monitor used for improving @entity1 outcome has not been assessed prospectively. This study explores whether the type of @entity428 monitoring device used affects the neurologic outcomes of @entity1 with @entity131 . METHODS: A prospective, observational study was conducted in 122 @entity1 with @entity131 >= 13 years old with indications for monitoring who were being treated in neurosurgical intensive care units between January 2009 and December 2012. All enrolled @entity1 required monitoring randomly using an external ventricular drain (EVD) or intraparenchymal fiberoptic monitor (IPM). @entity1 were placed into 2 groups depending on the type of monitoring device. Clinically relevant outcomes, refractory intracranial @entity101 , survival rates, and device-related complications were compared between the 2 groups. RESULTS: There was a significant between-group difference in the Glasgow Outcome Scale score 6 months after injury, which was the primary outcome. Refractory intracranial @entity101 was diagnosed in 44 of 122 @entity1 , and @entity1 monitored using IPM had a higher percentage of refractory intracranial @entity101 (51.7% vs. 21.0%, P < 0.001). The 1-month survival rate was 90.3% in the EVD group and 76.7% in the IPM group (log-rank test, P  = 0.04), and @entity1 managed with EVDs had a significantly higher 6-month postinjury survival rate compared with @entity1 treated with IPMs (88.7% vs. 68.3%, log-rank test, P  = 0.006). There was no statistically significant difference between the groups in device-related complications (P  = 0.448). CONCLUSIONS: Device selection for @entity428 monitoring provides prognostic discrimination, and use of EVDs may have a bigger advantage in controlling refractory intracranial @entity101 . Based on our findings, we recommend routine placement of an EVD in @entity1 with @entity131 , unless only parenchymal-type monitoring is available.
