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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0046-1815946
Research Article

A 7-Point Risk Stratification Tool for EVD Placement in Acute Intracerebral Hemorrhage: A Multivariable Analysis and the Development of Novel Predictive Score (EVD-ICH Score)

Autor*innen

  • Mohsin Fayaz

    1   Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

  • Farhaan Parvaiz Bhat 

    1   Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

  • Sarabjit Singh Chibber

    1   Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

  • Mohd Ashraf Ganie

    2   Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

  • Abdul Haseeb Wani

    4   Department of Radiodiagnosis and Imaging, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

  • Saqib Hassan

    3   Department of Biotechnology, Sathyabama Institute of Science and Technology (Deemed University), Chennai, Tamil Nadu, India
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Abstract

Background

Intracerebral hemorrhage (ICH) is associated with high morbidity and mortality. Intraventricular extension (IVE) and hydrocephalus (HCP) frequently prompt external ventricular drain (EVD) insertion, but objective criteria to guide EVD use are lacking.

Aims

This article aims to identify clinical and radiological predictors of EVD insertion in spontaneous ICH and to develop a simple bedside scoring system (EVD-ICH score) to support decision-making.

Materials and Methods

This is a prospective observational study of 100 consecutive adults with spontaneous nontraumatic ICH admitted to a tertiary-care center (March 2023 to February 2024). Clinical and CT variables were recorded. Multivariable logistic regression identified independent predictors of EVD insertion. A points-based score was created from adjusted odds ratios and internally validated using receiver operating characteristic (ROC) analysis.

Results

Of 100 patients, predictors independently associated with EVD insertion were IVE, HCP, Glasgow coma scale (GCS) ≤ 8, hematoma volume ≥30 mL, and history of hypertension (HTN). The 7-point EVD-ICH score (IVE 2 pts, HCP 2 pts, GCS ≤8 1 pt, ICH ≥30 mL 1 pt, HTN 1 pt) achieved an area under the ROC curve (AUC) of 0.85 (95% CI: 0.78–0.92). Optimal cut-off ≥3 yielded a sensitivity of 80% and a specificity of 77%. Predicted EVD probability ranged from 8% (score 0) to 92% (score 7).

Conclusion

The EVD-ICH score provides a concise bedside tool to stratify risk of requiring EVD in spontaneous ICH. External multicenter validation and assessment of impact on patient-centered outcomes are recommended before routine adoption.

Keywords

intraventricular hemorrhage - hydrocephalus - Glasgow coma scale - scoring system - risk assessment

Authors' Contributions

All the authors have read and approved the manuscript.


Ethical Approval

Being an observational prospective study, the study was exempted by the Institutional Ethics Committee of SKIMS. The study was conducted in accordance with the Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects.


Patients' Consent

A written consent to participate in the study was taken from the patient or next of kin.




Publikationsverlauf

Artikel online veröffentlicht:
03. Februar 2026

© 2026. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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