Clinical Outcomes Of EVD Placement In IVH Patients At Kenyatta National Hospital

Abstract

Background: Intraventricular hemorrhage (IVH) is a severe neurological condition commonly managed with external ventricular drains (EVD). Despite its widespread use at Kenyatta National Hospital, there is limited research evaluating clinical outcomes of EVD placement in IVH patients in this setting. Objectives: This study aims to assess the clinical outcomes of EVD placement in IVH patients at Kenyatta National Hospital, focusing on survival rates, complications, and postoperative quality of life. Methods: A prospective cross-sectional study design was employed, including 45 IVH patients who underwent EVD placement. Participants were selected consecutively based on inclusion criteria. Descriptive statistics were used for continuous variables such as age and duration of hospital stay, while categorical variables like gender and type of IVH were analyzed using frequency distributions. Statistical tests, including Fisher's exact test and logistic regression, identified significant predictors of clinical outcomes. Kaplan-Meier survival curves and Cox proportional hazard models were used to analyze time-to-event data. Results: Among the 45 patients, the mean age was 60 years, with 68% male. Hypertension was present in 42%. The average time to presentation was 13.8 hours, and mean Glasgow Coma Scale (GCS) at admission was 9.9. A majority (93%) also had intracerebral hemorrhage (ICH). EVD placement occurred an average of 29 hours post-admission. Post-EVD, 49% of patients showed improved GCS scores, while 11% worsened. Mortality within 30 days was 31%, with significant predictors including older age, lower GCS, higher Graeb scores, and higher Evans index. Ridge regression identified age, time to presentation, GCS, hypertension, and Graeb score as predictors of mortality and functional outcomes. Conclsion: Older age, lower GCS scores, higher Graeb scores, and hypertension significantly predicted higher mortality and worse functional outcomes following EVD placement in IVH patients. Early EVD intervention improved survival, emphasizing the need for prompt and comprehensive management in this population.