Postoperative drainage for 6, 12, or 24 h after burr-hole evacuation of chronic subdural hematoma in symptomatic patients (DRAIN-TIME 2): study protocol for a nationwide randomized controlled trial

Mads Hjortdal Grønhøj*, Thorbjørn Søren Rønn Jensen, Ann Kathrine Sindby, Rares Miscov, Torben Hundsholt, Birgit Debrabant, Carsten Reidies Bjarkam, Bo Bergholt, Kåre Fugleholm, Frantz Rom Poulsen

*Corresponding author for this work

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Abstract

Background: Chronic subdural hematoma (CSDH) is a common acute or subacute neurosurgical condition, typically treated by burr-hole evacuation and drainage. Recurrent CSDH occurs in 5–20% of cases and requires reoperation in symptomatic patients, sometimes repeatedly. Postoperative subdural drainage of maximal 48 h is effective in reducing recurrent hematomas. However, the shortest possible drainage time without increasing the recurrence rate is unknown. Methods: DRAIN-TIME 2 is a Danish multi-center, randomized controlled trial of postoperative drainage time including all four neurosurgical departments in Denmark. Both incapacitated and mentally competent patients are enrolled. Patients older than 18 years, free of other intracranial pathologies or history of previous brain surgery, are recruited at the time of admission or no later than 6 h after surgery. Each patient is randomized to either 6, 12, or 24 h of passive subdural drainage following single burr-hole evacuation of a CSDH. Mentally competent patients are asked to complete the SF-36 questionnaire. The primary endpoint is CSDH recurrence rate at 90 days. Secondary outcome measures include SF-36 at 90 days, length of hospital stay, drain-related complications, and complications related to immobilization and mortality. Discussion: This multi-center trial will provide evidence regarding the shortest possible drainage time without increasing the recurrence rate. The potential impact of this study is significant as we believe that a shorter drainage period may be associated with fewer drain-related complications, fewer complications related to immobilization, and shorter hospital stays—thus reducing the overall health service burden from this condition. The expected benefits for patients’ lives and health costs will increase as the CSDH patient population grows. Trial registration: ISRCTN Registry ISRCTN15186366. Registered in December 2020 and updated in October 2021. This protocol was developed in accordance with the SPIRIT Checklist and by use of the structured study protocol template provided by BMC Trials.

Original languageEnglish
Article number213
JournalTrials
Volume23
Number of pages14
ISSN1745-6215
DOIs
Publication statusPublished - 14. Mar 2022

Bibliographical note

Publisher Copyright:
© 2022, The Author(s).

Keywords

  • Chronic subdural hematoma
  • Drain
  • Neurology
  • Neurosurgery
  • Randomized control trial
  • Recurrent chronic subdural hematoma
  • Drainage/adverse effects
  • Humans
  • Postoperative Period
  • Craniotomy/adverse effects
  • Randomized Controlled Trials as Topic
  • Subdural Space/surgery
  • Hematoma, Subdural, Chronic/surgery
  • Multicenter Studies as Topic

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