Drains Following Burr-Hole Evacuation Reduce Hematoma Recurrence

A new study has shown that creating drains after burr-hole evacuation of a chronic subdural hematoma can improve clinical outcomes, drastically reducing recurrence and mortality.

Researchers at the University of Cambridge (United Kingdom) conducted a randomized controlled trial between November 2004 and November 2007 that involved 269 patients aged 18 years and older with a chronic subdural hematoma. The patients were evaluated and assessed for eligibility for burr-hole drainage. Of these, 108 were randomly assigned by block randomization to receive a drain inserted into the subdural space, and 107 to no drain after evacuation. The primary endpoint was recurrence necessitating a repeat drainage.

The researchers found that recurrence occurred in 10 of 108 (9.3%) people with a drain, and 26 of 107 (24%) without. At six months, mortality was 9 of 105 (8.6%) and 19 of 105 (18.1%), respectively. The researchers reported that at discharge, patients with drains had better functional status, tended to have favorable modified Rankin scores, a Glasgow coma score of 15, and fewer neurological deficits than those without drains. Medical and surgical complications were about the same between groups.

The trial was stopped early because of a significant benefit in reduction of recurrence, and analyses were done on an intention-to-treat basis. The study was published in the September 26, 2009, issue of the Lancet.

"The question of drain or no drain has called for a randomized clinical trial for decades - and here it is, impeccably done,” said Timo Koivisto, M.D., and Juha Jääskeläinen, M.D., of the department of neurosurgery at Kuopio University Hospital (Finland), in an accompanying comment. "The use of a drain drastically reduced recurrences, management, and mortality. [The] ... study should be circulated to every neurosurgical department.”

Related Links:
University of Cambridge
Kuopio University Hospital