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Accessing the Subdural Space of the Rodent Spinal Cord for Treatment Delivery
Published on: August 8, 2025
Clinical audit effectively bridges the evidence-practice gap in chronic subdural haematoma management
Jignesh Tailor1, D Fernando2, Z Sidhu2
1Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5, UK. jktailor@gmail.com.
Insights
Subdural drains significantly reduce chronic subdural hematoma recurrence after surgery. Despite evidence, consistent use remains a challenge, highlighting the need for clinical audits to improve patient outcomes.
Area of Science:
- Neurosurgery
- Clinical Audit
- Evidence-Based Medicine
Background:
- Randomized controlled trials (RCTs) demonstrate subdural drains reduce chronic subdural hematoma (CSDH) recurrence.
- A 2009 RCT provided class I evidence supporting subdural drain use.
- Clinical practice adoption of subdural drains post-RCT publication remains uncertain.
Purpose of the Study:
- To audit the use of subdural drains in CSDH management.
- To assess the impact of a 2009 RCT on clinical practice regarding subdural drain use.
- To evaluate recurrence rates and complications associated with subdural drain placement.
Main Methods:
- A longitudinal retrospective study analyzed adult patients undergoing burr holes for CSDH (Jan 2009 - Jan 2014).
- Data collected included subdural drain usage, re-operation for recurrence, and complications.
- The audit loop was closed with follow-up data (Aug 2015 - Jan 2016).
Main Results:
- Subdural drain placement was associated with significantly lower reoperation rates (8% vs. 17%, p=0.021).
- Drain usage doubled post-2009 RCT publication, increasing from 35% to 75% of cases.
- Complication rates were not increased by drain placement, but significant variability in utilization persisted.
Conclusions:
- Subdural drain use effectively reduces CSDH recurrence, confirming prior trial findings.
- While drain utilization doubled, significant variability in practice persists.
- Clinical audit is an effective tool for implementing evidence-based practices like subdural drain placement.
Background:
Placement of a subdural drain after drainage of chronic subdural haematoma (CSDH) has been shown to reduce the rate of recurrence in several randomised controlled trials (RCT). The most recently published RCT was from Cambridge, UK, in 2009. Despite class I evidence for the use of subdural drains, it is unclear whether these results have been translated into clinical practice. In this clinical audit we review the use of subdural drains in our institution before and after the publication of the 2009 RCT results.
Methods:
A longitudinal retrospective study was performed on all adults having burr holes for CSDH between January 2009 and January 2014. Case notes were analysed to determine subdural drain use, re-operation for CSDH recurrence and post-operative complications. The audit loop was closed with data collected from August 2015 to January 2016.
Results:
Thirty-one per cent of patients had subdural drains placed at operation. Drain placement was associated with lower reoperation rates (8% vs. 17%, p = 0.021) without increasing complication rates. Drain usage doubled after publication of the Santarius et al. (2009) trial but we observed persisting and significant variability in drain utilisation by supervising consultants. The use of drains in the department increased from 35% to 75% of all cases after presentation of these results.
Conclusions:
The use of subdural drains in our unit reduced recurrence rates following drainage of CSDH and reproduced the results of a 2009 clinical trial. Although the use of subdural drains doubled in the post-trial epoch, significant variability remains in practice. Clinical audit provided an effective tool necessary to drive the implementation of subdural drain placement in our unit.
