Combination of Conventional EVD and Ommaya Drainage for Intraventricular Hemorrhage (IVH)

Figures & data

Figure 1 Flowchart of study enrollment.

Abbreviations: IVH, intraventricular hemorrhage; EVD, external ventricular drainage.

Table 1 Demographic, Clinical, and Neuroradiological Characteristics of Patients

Variables	Classes	Unused Ommaya (N=48)	Used Ommaya (N=75)	P value	Sig.
Age		52.40 ± 15.04	54.64 ± 13.41	0.3898	ns
Gender	Male	31 (64.6%)	52 (69.3%)	0.5833	ns
	Female	17 (35.4%)	23 (30.7%)		ns
Inpatient Time		16.46 ± 9.177	25.65 ± 12.57	<0.0001	****
Hypertension	(+)	33 (68.8%)	63 (84.0%)	0.0727	ns
	(-)	15 (31.2%)	12 (16.0%)
UK_Use	(+)	5 (10.4%)	44 (58.7%)	<0.0001	****
	(-)	43 (89.6%)	31 (41.3%)
VP Shunt	(+)	9 (18.8%)	22 (29.3%)	0.2085	ns
	(-)	39 (81.2%)	53 (70.7%)
Intracranial Infection	(+)	6 (12.5%)	11 (14.7%)	0.7951	ns
	(-)	42 (87.5%)	64 (85.3%)
GCS		11.92 ± 1.724	8.920 ± 2.954	<0.0001	****
mGS_before		14.21 ± 3.831	16.31 ± 5.342	0.0035	**
mGS_3d		11.17 ± 4.091	13.48 ± 5.356	0.0139	*
mGS_7d		6.688 ± 3.909	9.027 ± 5.128	0.017	*
mGS_diff.		7.521 ± 3.579	7.280 ± 4.558	0.5855	ns
GOS_after 3 months		3.917 ± 0.9639	3.107 ± 0.9526	<0.0001	****
EVD_Time		9.208 ± 2.760	10.60 ± 4.233	0.1096	ns

Notes: (+) denotes the patient group who has the variables; (-) denotes the patient group who does not have the variables; ns means no significance; *denotes for “P<0.05”; **denotes for “P<0.01”; ****denotes for “P<0.0001”.

Abbreviations: GCS, the Glasgow Coma Scale; mGS, the modified Graeb Score; GOS, the Glasgow Outcome Scale; EVD, external ventricular drain; UK, intraventricular urokinase therapy; VP shunt, ventriculoperitoneal shunt.

Figure 2 Performance comparison between the groups regarding the different clinical scores recorded at different times during the course with univariate analysis. The patients in the Ommaya-used group showed a lower the GCS before drainage (A), 3-month GOS (B) than those in the Ommaya-unused group. No significance difference was found between the baseline mGS and the mGS 7 days later (C), although there were significant differences in the mGS before drainage (D), 3-day mGS (E) and 7-day mGS (F) postoperatively between the groups. n.s. denotes for no significance; *denotes for “P<0.05”; **denotes for “P<0.01”; ****denotes for “P<0.0001”.

Figure 3 Imaging of IVH patients shown as representative cases. CT scans performed before, 3d and 7d after surgery of Ommaya-used group and Ommaya-unused group. The mGS scores were 20 (before surgery), 16 (3d after surgery) and 5 (7d after surgery) of representative case in Ommaya-used group. The mGS scores were 13 (before surgery), 11 (3d after surgery) and 5 (7d after surgery) of representative case in Ommaya-unused group.

Table 2 Linear Regression Analysis Between Independent Clinical Factors and Clinical Outcomes

Variable	Estimate	Standard Error	95% Confidence Interval	|t|	p value	Sig.
Intercept	2.771	0.6928	1.397 to 4.144	3.999	0.0001	***
GCS	0.1763	0.03742	0.1021 to 0.2505	4.711	<0.0001	****
Ommaya_Time	0.03628	0.01189	0.01271 to 0.05985	3.052	0.0029	**
Age	−0.01466	0.006379	−0.02731 to −0.002014	2.298	0.0235	*
Inpatient_Time	−0.03394	0.009355	−0.05248 to −0.01539	3.628	0.0004	***

Note: R² = 0.6332, R²adj = 0.5818, SS_regression/SS_total = 82.32/130, F = 12.31, p < 0.0001. *denotes for “P<0.05”; **denotes for “P<0.01”; ***denotes for “P<0.001”; ****denotes for “P<0.0001”.

Figure 4 Binomial logistic regression analysis for predicting the probability of using Ommaya. The omnibus likelihood ratio tests showed that the preoperative GCS was the main significant predictor in the model (p<0.001), and the preoperative mGS was marginally significant (p = 0.086). The model showed satisfactory performance in predicting the usage of the Ommaya reservoir. The model achieved an AUC of 0.82 (A), and an accuracy of 0.74, a specificity of 0.79, a sensitivity of 0.67 (B), when the cut-off value was set to 0.5.