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Cochrane Database of Systematic Reviews

Drenajes externos versus ningún drenaje después de la evacuación mediante trepanación en el tratamiento del hematoma subdural crónico en pacientes adultos

Información

DOI:
https://doi.org/10.1002/14651858.CD011402.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 31 agosto 2016see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Lesiones

Copyright:
  1. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Deqing Penga

    Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, China

    Department of Neurosurgery, Zhejiang Provincial People's Hospital, Hangzhou City, China

    Both authors contributed equally to this work

  • Yongjian Zhua

    Correspondencia a: Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, China

    [email protected]

    Both authors contributed equally to this work

Contributions of authors

DP and YZ assessed the eligibility of identified studies and extracted data from included studies. DP entered data, performed analysis, and wrote the first draft of the review. DP and YZ commented on the paper.

Sources of support

Internal sources

  • The Second Affiliated Hospital of Zhejiang University School of Medicine and Zhejiang Provincial People's Hospital, China.

External sources

  • No sources of support supplied

Declarations of interest

DP: none known
YZ: none known

Acknowledgements

We thank the Cochrane Injuries Group for their continued support and guidance throughout the development of this review, especially Deirdre Beecher, Emma Sydenham, Sarah Dawson and Elizabeth Royle. Also, we are grateful to Ruxin Xing, who as an experienced author helped us considerably from protocol to review.

This project was supported by the UK National Institute for Health Research, through Cochrane Infrastructure funding to the Cochrane Injuries Group. The views and opinions expressed are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

Version history

Published

Title

Stage

Authors

Version

2016 Aug 31

External drains versus no drains after burr‐hole evacuation for the treatment of chronic subdural haematoma in adults

Review

Deqing Peng, Yongjian Zhu

https://doi.org/10.1002/14651858.CD011402.pub2

2014 Nov 22

Drains versus no drains after burr‐hole evacuation for the treatment of chronic subdural haematoma in adults

Protocol

Deqing Peng, Yongjian Zhu

https://doi.org/10.1002/14651858.CD011402

Differences between protocol and review

Review title

Changed from 'Drains versus no drains after burr‐hole evacuation for the treatment of chronic subdural haematoma in adults' in the protocol to 'External drains versus no drains after burr‐hole evacuation for the treatment of chronic subdural haematoma in adults' for the review.

Search methods

Since the search methods were agreed for the protocol the register, Current Controlled Trials (www.controlled‐trials.com/mrct/) service is now under review. For this reason it has not been searched however searching the International Clinical Trials Registry Platform (who.int/ictrp/en/) should have retrieved most registered trials.

We searched PubMed to retrieve references that were not indexed in MEDLINE or Embase.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Adult; Humans;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram
Figuras y tablas -
Figure 1

Study flow diagram

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies. Nine studies are included in this review.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies. Nine studies are included in this review.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Comparison of drains versus no drains, Outcome 1 Recurrence.
Figuras y tablas -
Analysis 1.1

Comparison 1 Comparison of drains versus no drains, Outcome 1 Recurrence.

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Comparison 1 Comparison of drains versus no drains, Outcome 2 Complications.
Figuras y tablas -
Analysis 1.2

Comparison 1 Comparison of drains versus no drains, Outcome 2 Complications.

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Comparison 1 Comparison of drains versus no drains, Outcome 3 Mortality.
Figuras y tablas -
Analysis 1.3

Comparison 1 Comparison of drains versus no drains, Outcome 3 Mortality.

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Comparison 1 Comparison of drains versus no drains, Outcome 4 Poor functional outcome.
Figuras y tablas -
Analysis 1.4

Comparison 1 Comparison of drains versus no drains, Outcome 4 Poor functional outcome.

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Comparison 1 Comparison of drains versus no drains, Outcome 5 Sensitivity analysis of recurrence.
Figuras y tablas -
Analysis 1.5

Comparison 1 Comparison of drains versus no drains, Outcome 5 Sensitivity analysis of recurrence.

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Summary of findings for the main comparison. Drains compared to no drains for burr‐hole evacuation of CSDH in adults

Drains compared to no drains for burr‐hole evacuation of CSDH in adults

Patient or population: adults with burr‐hole evacuation of CSDH

Settings: hospital settings in India,Turkey, Iran, Germany, UK and Japan
Intervention: one or more drains
Comparison: no drains

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

No drain

Drain

Overall recurrence
Follow‐up: 3 weeks‐6 months

Study population

RR 0.45
(0.32 to 0.61)

968
(9 studies)

⊕⊕⊕⊝
moderate1

216 per 1000

97 per 1000
(69 to 132)

Moderate

231 per 1000

104 per 1000
(74 to 141)

Recurrence with 2 burr holes (subgroup)
Follow‐up: 6 months

Study population

RR 0.46
(0.26 to 0.8)

306
(3 studies)

⊕⊕⊝⊝
low1,2

216 per 1000

99 per 1000
(56 to 173)

Moderate

231 per 1000

106 per 1000
(60 to 185)

Recurrence with 1 burr hole (subgroup)
Follow‐up: 6 months

Study population

RR 0.17
(0.05 to 0.56)

156
(2 studies)

⊕⊕⊝⊝
low1,2

211 per 1000

36 per 1000
(11 to 118)

Moderate

213 per 1000

36 per 1000
(11 to 119)

Recurrence with 1 or 2 burr holes (subgroup)
Follow‐up: 3 weeks‐6 months

Study population

RR 0.52
(0.34 to 0.79)

506
(4 studies)

⊕⊕⊕⊝
moderate1

218 per 1000

113 per 1000
(74 to 172)

Moderate

213 per 1000

111 per 1000
(72 to 168)

Complications
Follow‐up: 3 weeks‐6 months

Study population

RR 1.15
(0.77 to 1.72)

710
(7 studies)

⊕⊕⊝⊝
low1,2

110 per 1000

127 per 1000
(85 to 190)

Moderate

100 per 1000

115 per 1000
(77 to 172)

Mortality
Follow‐up: 6 months

Study population

RR 0.78
(0.45 to 1.33)

539
(5 studies)

⊕⊕⊝⊝
low1,2

100 per 1000

78 per 1000
(45 to 133)

Moderate

56 per 1000

44 per 1000
(25 to 74)

Poor functional outcome (includes death)
Follow‐up: 6 months

Study population

RR 0.68
(0.44 to 1.05)

490
(5 studies)

⊕⊕⊝⊝
low1,2

169 per 1000

115 per 1000
(74 to 177)

Moderate

131 per 1000

89 per 1000
(58 to 138)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Only one trial used adequate allocation concealment, and one trial used alternation as a randomisation method (Wakai 1990).
2 Downgraded one level for imprecision: estimate based on few events and wide CIs.

Figuras y tablas -
Summary of findings for the main comparison. Drains compared to no drains for burr‐hole evacuation of CSDH in adults
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Comparison 1. Comparison of drains versus no drains

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Recurrence Show forest plot

9

968

Risk Ratio (M‐H, Fixed, 95% CI)

0.45 [0.32, 0.61]

1.1 Two holes

3

306

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.26, 0.80]

1.2 One hole

2

156

Risk Ratio (M‐H, Fixed, 95% CI)

0.17 [0.05, 0.56]

1.3 One or two holes

4

506

Risk Ratio (M‐H, Fixed, 95% CI)

0.52 [0.34, 0.79]

2 Complications Show forest plot

7

710

Risk Ratio (M‐H, Fixed, 95% CI)

1.15 [0.77, 1.72]

3 Mortality Show forest plot

5

539

Risk Ratio (M‐H, Fixed, 95% CI)

0.78 [0.45, 1.33]

4 Poor functional outcome Show forest plot

5

490

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.44, 1.05]

5 Sensitivity analysis of recurrence Show forest plot

7

802

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.22, 0.50]
Figuras y tablas -
Comparison 1. Comparison of drains versus no drains
Ir a la tabla de la revisión