Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial

被引：514

作者：

Santarius, Thomas ^{[1
]}

Kirkpatrick, Peter J. ^{[1
]}

Ganesan, Dharmendra ^{[1
]}

Chia, Hui Ling ^{[1
]}

Jalloh, Ibrahim ^{[1
]}

Smielewski, Peter ^{[1
]}

Richards, Hugh K. ^{[1
]}

Marcus, Hani ^{[1
]}

Parker, Richard A. ^{[2
]}

Price, Stephen J. ^{[1
]}

Kirollos, Ramez W. ^{[1
]}

Pickard, John D. ^{[1
]}

Hutchinson, Peter J. ^{[1
]}

机构：

[1] Univ Cambridge, Addenbrookes Hosp, Dept Neurosurg, Cambridge CB2 2QQ, England

[2] Univ Cambridge, Ctr Appl Med Stat, Dept Publ Hlth & Primary Care, Cambridge, England

来源：

LANCET | 2009年 / 374卷 / 9695期

关键词：

CLOSED-SYSTEM DRAINAGE; MANAGEMENT; RECURRENCE; SURGERY;

D O I：

10.1016/S0140-6736(09)61115-6

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Chronic subdural haematoma causes serious morbidity and mortality. It recurs after surgical evacuation in 5-30% of patients. Drains might reduce recurrence but are not used routinely. Our aim was to investigate the effect of drains on recurrence rates and clinical outcomes. Methods We did a randomised controlled trial at one UK centre between November, 2004, and November, 2007. 269 patients aged 18 years and older with a chronic subdural haematoma for burr-hole drainage were assessed for eligibility 108 were randomly assigned by block randomisation to receive a drain inserted into the subdural space and 107 to no drain after evacuation. The primary endpoint was recurrence needing redrainage. The trial was stopped early because of a significant benefit in reduction of recurrence. Analyses were done on an intention-to-treat basis. This study is registered with the International Standard Randomised Controlled Trial Register (ISRCTN 97314294). Findings Recurrence occurred in ten of 108 (9.3%) people with a drain, and 26 of 107 (24%) without (p=0003; 95% CI 0.14-0.70). At 6 months mortality was nine of 105 (8.6%) and 19 of 105 (18.1%), respectively (p=0.042; 95% CI 0.1-0.99). Medical and surgical complications were much the same between the study groups. Interpretation Use of a drain after burr-hole drainage of chronic subdural haematoma is safe and associated with reduced recurrence and mortality at 6 months. Funding Academy of Medical Sciences, Health Foundation, and NIHR Biomedical Research Centre (Neurosciences Theme).

引用

页码：1067 / 1073

页数：7

共 21 条

[1] Outcomes validity and reliability of the modified Rankin scale: Implications for stroke clinical trials - A literature review and synthesis [J].