ArticleNeurocritical care2020
Quantitative Modeling of External Ventricular Drain Output to Predict Shunt Dependency in Aneurysmal Subarachnoid Hemorrhage: Cohort Study.
Article in Neurocritical care, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 3 syntheses or guidelines pooled it, 29 citations in OpenAlex.
- The efficacy of machine learning algorithms in evaluating factors associated with shunt-dependent hydrocephalus after subarachnoid hemorrhage: a systematic review and meta-analysis.Neurosurgical review · 2025Pooled it
- Rapid Versus Gradual Weaning of External Ventricular Drain: A Systematic Literature Review and Meta-analysis.Neurocritical care · 2023Pooled it
- Cerebrospinal fluid predictors of shunt-dependent hydrocephalus after hemorrhagic stroke: a systematic review and meta-analysis.Neurosurgical review · 2022Pooled it
- Development of the IS-Score: A Novel Predictive Model for Shunt Requirement Following Aneurysmal Subarachnoid Hemorrhage.Neurocritical care · 2026Article
- Early Prediction of External Ventricular Drain Weaning Trial Outcome in Patients with SAH Based on ICP Pulse Morphological Similarity: A Single-Center Retrospective Cohort Analysis.Neurocritical care · 2026Article
- Changes in serum sodium during an external ventricular drain weaning in patients with subarachnoid hemorrhage.Frontiers in neurology · 2026Article
- Letter regarding Pereira et al.'s SAH-VP score: Methodological and statistical considerations.Brain & spine · 2025Article
- Machine learning in developing a predictive model for chronic hydrocephalus following aneurysmal subarachnoid hemorrhage.Frontiers in neurology · 2025Article
- Predictive factors for ventriculoperitoneal shunt placement in aneurysmatic subarachnoid hemorrhages.Brain & spine · 2025Article
- Article
- Predictors of shunt insertion in patients with aneurysmal subarachnoid haemorrhage-a single-centre retrospective analysis.Acta neurochirurgica · 2024Article
- A predictive model in patients with chronic hydrocephalus following aneurysmal subarachnoid hemorrhage: a retrospective cohort study.Frontiers in neurology · 2024Article
- The Role of Cisternostomy and Cisternal Drainage in the Treatment of Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Review.Brain sciences · 2023Review
- Predicting Shunt Dependency from the Effect of Cerebrospinal Fluid Drainage on Ventricular Size.Neurocritical care · 2022Observational
- Association of External Ventricular Drain Wean Strategy with Shunt Placement and Length of Stay in Subarachnoid Hemorrhage: A Prospective Multicenter Study.Neurocritical care · 2022Observational
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAcute hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH); however, attempts to predict shunt-dependent chronic hydrocephalus using clinical parameters have been equivocal.
methodsCohort study of aSAH is treated with external ventricular drainage (EVD) placement at our institution, 2001-2016, via logistic regression. EVD-related parameters included mean/total EVD output (days 0-2), EVD days, EVD days ≤ 5 mmHg, and wean/clamp fails. aSAH outcomes assessed included ventriculoperitoneal shunt (VPS) placement, delayed cerebral ischemia (DCI), radiographic infarction (RI), symptomatic vasospasm (SV), age, and aSAH grades.
resultsTwo hundred and ten aSAH patients underwent EVD treatment for a median 12 days (range 1-54); 85 required VPS (40%). On univariate analysis, EVD output, total EVD days, EVD days ≤ 5 mmHg, and wean/clamp trial failures were significantly associated with VPS placement (p < 0.01 for all parameters). No EVD output parameter demonstrated a significant association with DCI, RI, or SV. On multivariate analysis, EVD output was a significant predictor of VPS placement, after adjusting for age and clinical and radiological grades; the optimal threshold for predicting VPS placement was mean daily output > 204 ml on days 0-2 (OR 2.59, 95% CI 1.31-5.07). Multiple wean failures were associated with unfavorable functional outcome, after adjusting for age, grade, and VPS placement (OR 1.65, 95% CI 1.10-2.47). We developed a score incorporating age, grade and EVD parameters (MAGE) for predicting VPS placement after aSAH.
conclusionsEVD output parameters and wean/clamp trial failures predicted shunt dependence in an age- and grade-adjusted multivariable model. Early VPS placement may be warranted in patients with MAGE score ≥ 4, particularly following 2 failed wean trials.
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