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. 2026 Jan;61(1):162537.
doi: 10.1016/j.jpedsurg.2025.162537. Epub 2025 Aug 12.

Under pressure: Identifying factors for pediatric patients with severe traumatic brain injury who benefit from external ventricular drainage

Erin West  1 , Utsav M Patwardhan  2 , Richard Calvo  3 , Andrea Krzyzaniak  4 , Michael Krzyzaniak  5 , Vishal Bansal  6 , Michael Sise  7 , Vijay M Ravindra  8 , David Gonda  9 , Romeo C Ignacio Jr  10
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Free article

Under pressure: Identifying factors for pediatric patients with severe traumatic brain injury who benefit from external ventricular drainage

Erin West et al. J Pediatr Surg. 2026 Jan.
Free article

Abstract

Purpose: The role of external ventricular drainage (EVD) in the management of pediatric traumatic brain injury (TBI) has been evolving with discrepancies between existing guidelines and clinical practice. Recently, EVDs were associated with better discharge disposition than intracranial pressure (ICP) monitoring alone. Using a large national database, we sought to identify which patients benefited the most from EVD placement.

Methods: In this retrospective cohort study, children (<16 years) with severe blunt TBI (GCS ≤8 or categorized as incapacitated) who received an EVD within 48 h of admission were identified in the Trauma Quality Improvement Program (TQIP) from 2016 to 2022. Injury severity, type of intracranial injury, and the EVD procedure utilization at each center were evaluated. The primary outcome was discharge disposition. Stratified competing risk survival models were utilized for multivariate analyses.

Results: A total of 898 patients were included with a mean age of 8.44 years. There were 194 deaths (21.6 %). On univariate analysis, Injury Severity Score (ISS), head Abbreviated Injury Severity Score (AIS), and Glasgow Coma Scale (GCS) were associated with adverse discharge. On multivariate modeling, ISS (HR 4.04, p < 0.001) and cerebral edema (HR 1.58, p = 0.038) were associated with adverse discharge. Epidural hematoma (HR 0.21, p = 0.03) and center EVD utilization (HR 0.82, p = 0.013) were associated with favorable discharge.

Conclusion: Patient factors such as injury severity score and the presence of cerebral edema are predictive of mortality or discharge to hospice after EVD placement. Patients admitted to higher-utilization centers for EVD are more likely to return home.

Level of evidence: Level III.

Keywords: Discharge; External ventricular drainage; Intracranial hypertension; Pediatric traumatic brain injury; Trauma quality program; Ventriculostomy.

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Conflict of interest statement

Conflicts of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.