Summary 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=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. 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).
The general consensus to optimize the care for severe TBI patients is management at specialized neurotrauma centers with neurosurgical and neurocritical care support and the use of guidelines-based ...standardized protocols. Over the last decade, significant efforts have been made to define neurotrauma treatment guidelines. However, it is important to recognize the heterogeneity of TBI and that the "one-size-fits-all approach" may not always be appropriate for these patients. Knowledge synthesis activities in neurotrauma are important to define future research agendas. Clinical and research advances have influenced neurotrauma as it continues to mature into a distinct subspecialty of neurosurgery.
Management of patients with head injury Mendelow, A David, Prof; Timothy, Jake, FRCS; Steers, James W, FRCS ...
The Lancet (British edition),
08/2008, Letnik:
372, Številka:
9639
Journal Article
Recenzirano
Revised UK guidelines from the National Institute for Health and Clinical Excellence (NICE) for the management of acute head injury address the initial management and triage/ Evidence has also shown ...that even patients who have sustained a minor head injury have difficulty reintegrating into society.5 Thus, management of head injury is an important topic. The principles for the triage of patients with head injuries were set out in the Royal College of Surgeons' report in 2005.11 This report and the Scottish Intercollegiate Guidelines Network6 were largely based on clinical risk factors and the presence of a skull fracture radiograph.15 This approach resulted in about 5% of patients (about 50000 patients per year in the UK) with head injury proceeding to a CT scan.
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