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


RESULTS
Recurrence occurred in ten of 108 (9.3%) people with a drain, and 26 of 107 (24%) without (p=0.003; 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.


CONCLUSIONS
Use of a drain after burr-hole drainage of chronic subdural haematoma is safe and associated with reduced recurrence and mortality at 6 months.


BACKGROUND
Academy of Medical Sciences, Health Foundation, and NIHR Biomedical Research Centre (Neurosciences Theme).
Santarius
Thomas
T
Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
Kirkpatrick
Peter J
PJ
Ganesan
Dharmendra
D
Chia
Hui Ling
HL
Jalloh
Ibrahim
I
Smielewski
Peter
P
Richards
Hugh K
HK
Marcus
Hani
H
Parker
Richard A
RA
Price
Stephen J
SJ
Kirollos
Ramez W
RW
Pickard
John D
JD
Hutchinson
Peter J
PJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003399:Craniotomy; D004322:Drainage; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome