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Hematoma, Subdural, ChronicECHONCT04573387

Exhaustive Drainage Versus Fixed-time Drainage for Chronic Subdural Hematoma After One-burr Hole Craniostomy

A study testing Operation, Fixed-time drainage and Exhaustive drainage in people with Hematoma, Subdural, Chronic, run by Beijing Tiantan Hospital at 17 sites in China.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

A prospective, multicenter, randomized controlled trial is designed to compare the recurrence rates and clinical outcomes in patients with chronic subdural hematoma using exhaustive drainage or fixed-time drainage after one-burr hole craniostomy. Read more about this study

Who is it for?
Ages 18 to 90 years
Conditions the study is for
Hematoma, Subdural, Chronic
What is being tested?
Operation, Fixed-time drainage and Exhaustive drainage
Could I receive a placebo?
No, everyone receives an active treatment
How many people
309 participants
Where
17 sitesChina
Study dates
29 Dec 2020to 15 Dec 2024
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 90 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patient (18 years to 90 years) presenting with clinical symptoms and neurological deficits of chronic subdural hematoma
  • Chronic subdural hematoma verified on cranial computed tomography or magnetic resonance imaging
  • Written informed consent from patients or their next of kin according to the patient's cognitive status

Who cannot join

  • No clinical symptoms correlating with chronic subdural hematoma
  • Lack of mass effect, less than 0.5 cm of midline structure shift, and no need surgery judged clinically by neurosurgeons
  • Previous surgery for chronic subdural hematoma during the past 6 months
  • Previous intracranial surgery for any neurological disorders but chronic subdural hematoma before
  • Existing poor medication condition or severe comorbidity so that surgery cannot be tolerated or follow-up cannot be completed
  • Severe coagulopathy or high risk of life-threatening bleeding
Show all 9Show fewer
  • Postoperative cooperation is suspected to be insufficient for follow-up for 6 months
  • Reproductive-age women without verified negative pregnancy testing
  • Participating in other research

Trial locations and contacts

17 sites in 1 country.

17 sites in 1 country

China17 sites
  • Beijing Ditan Hospital, Capital Medical University

    Beijing, Beijing Municipality, 100015

  • Beijing Chaoyang Hospital, Capital Medical University

    Beijing, Beijing Municipality, 100020

  • Beijing Xuanwu Hospital, Capital Medical University

    Beijing, Beijing Municipality, 100053

  • Beijing Tiantan Hospital, Capital Medical University

    Beijing, Beijing Municipality, 100070

  • Beijing Tongren Hospital, Capital Medical University

    Beijing, Beijing Municipality, 100730

  • Beijing Luhe Hospital, Capital Medical University

    Beijing, Beijing Municipality, 101100

  • Wangjing Hospital, China Academy of Chinese Medical Sciences

    Beijing, Beijing Municipality

  • Wei County Hospital of Traditional Chinese Medicine

    Handan, Hebei, 056800

  • Hengshui People's Hospital

    Hengshui, Hebei, 053000

  • First People's Hospital of Lianyungang

    Lianyungang, Jiangsu, 222061

  • Puning People's Hospital

    Puning, Guangdong, 515300

  • First Hospital of Qinhuangdao

    Qinhuangdao, Hebei, 066000

  • North China University of Science and Technology Affiliated Hospital

    Tangshan, Hebei, 063000

  • Tianjin Huanhu Hospital

    Tianjin, Tianjin Municipality, 300350

  • Yancheng Third People's Hospital

    Yancheng, Jiangsu, 224001

  • People's Hospital of Ningxia Hui Autonomous Region

    Yinchuan, Ningxia, 750002

  • Xiahuayuan District Hospital

    Zhangjiakou, Hebei, 075000

Other trials in China

About this study

Official title: A Randomized Controlled Trial of Exhaustive Drainage Versus Fixed-time Drainage for Chronic Subdural Hematoma After One-burr Hole Craniostomy

A prospective, multicenter, randomized controlled trial is designed to compare the recurrence rates and clinical outcomes in patients with chronic subdural hematoma using exhaustive drainage or fixed-time drainage after one-burr hole craniostomy.

Read the detailed description

Chronic subdural hematomas (CSDHs) are one of the most common neurosurgical conditions. The goal of surgery is to alleviate symptoms and minimize the risk of symptomatic recurrences. The standard surgical technique includes burr-hole craniostomy, followed by intraoperative irrigation and placement of subdural closed-system drainage. The drainage is removed after 48 hours, which can be described as fixed-time drainage strategy. According to literature, the recurrence rate is 5-33% with this strategy. In the investigators' retrospective study, postoperative hematoma volume (p=0.001, B=0.028, Exp(B)=1.028, 95% CI 1.011-1.046) was found to significantly increase the risk of recurrence. Based on these results, an exhaustive drainage strategy may minimize postoperative hematoma volume and achieve a low recurrence rate and good outcomes. This is a prospective, multicenter, randomized controlled trial designed to include 304 participants over the age of 18 years presenting with a symptomatic CSDH verified on cranial computed tomography or magnetic resonance imaging. After informed consent is obtained, participants are randomly allocated to an exhaustive drainage or fixed-time drainage group. The primary endpoint is recurrence indicating a reoperation within 6 months. Secondary outcomes include modified Rankin Scale, Markwalder Grading Scale, European Quality of Life-5 Dimensions-5 Levels (EQ-5D-5L), rate of complications, rate of adverse events and effect on comorbidity.

Being tested
Operation, Fixed-time drainage, Exhaustive drainage, Postoperative computed tomography
Keywords
chronic subdural hematoma, fixed-time drainage, exhaustive drainage, drainage, craniostomy, urokinase
Medical subject headings
Hematoma, Subdural, Chronic

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • OperationProcedure or surgery

    All participants are treated with burr-hole craniotomy and a drainage system as follows. Participants undergo surgical procedure under local anesthesia in the hemisphere with a lateral position, but general anesthesia is performed when participant cannot tolerate the operation. A single 1.5 cm burr hole is drilled over the maximum width of the hematoma cavity. After coagulating with bipolar diathermy, dura mater is opened with a cruciate incision. A soft catheter is placed carefully in all directions of the hematoma cavity for irrigating subdural collections with 1,000 mL warm Ringer's lactate saline until clarification. The drainage catheter is inserted ½ length of the maximum diameter of the hematoma cavity toward the frontal region. After the skin is closed, the catheter was connected to a soft collection bag that is placed under the head for passive drainage. During the drainage period, participants stay in bed until the drain is removed.

  • Fixed-time drainageProcedure or surgery

    All participants will be treated with a one-burr-hole craniotomy with irrigation and a closed drainage system. The drainage will be removed after 48 hours.

  • Exhaustive drainageProcedure or surgery

    All participants will be treated with a one-burr-hole craniotomy with irrigation and a closed drainage system. If the computed tomography (CT) scan on the first day after surgery indicates that the affected brain region shows sufficient re-expansion, the drainage catheter will be removed when drainage ceases. If subdural collections remain in the hematoma cavity, the participant will be treated with 30,000 U urokinase injection into the hematoma cavity through the catheter. The catheter will be closed and reopened in 1.5-2 hours, and a CT scan will be performed when drainage ceases. If the CT scan shows sufficient re-expansion of the brain, the catheter will be removed. However, if the brain does not show good re-expansion and there is still a residual subdural collection, the above steps will be repeated. If the participant is subjected to urokinase injection for 3 times, the catheter will be removed when drainage ceases.

  • Postoperative computed tomographyProcedure or surgery

    All participants undergo a CT scan before the drain is removed, and the last CT scan will be performed before the patient is discharged from the hospital.

Study groups in NCT04573387
Study groupRoleWhat they receive
Fixed-time drainageActive comparatorDrainage will be removed after 48 hours.
Receives: Procedure: Operation; Procedure: Fixed-time drainage; Procedure: Postoperative computed tomography
Exhaustive drainageExperimentalDrainage will be removed when postoperative hematoma volume is minimized with repeated urokinase injection into hematoma cavity through catheter.
Receives: Procedure: Operation; Procedure: Exhaustive drainage; Procedure: Postoperative computed tomography

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Rate of re-operations of chronic subdural hematoma

    Rate of re-operations between fixed-time drainage group and exhaustive drainage group

    Measured: From operation up to 6 months postoperatively

Secondary outcomes (5)
  1. Change of Modified Rankin Scale (MRS) between groups from baseline to 6 months after operation

    Modified Rankin Scale ranges from score 1 to 6, and higher scores mean a worse clinical outcome, where score 1 indicates normal daily functionality and score 6 indicates death.

    Measured: At baseline, and at 1, 3, and 6 months after operation

  2. Change of Markwalder Grading Scale (MGS) between groups from baseline to 6 months after operation

    Markwalder Grading Scale ranges from grade 0 to 4, and higher scores mean a worse neurological outcome, where grade 0 indicates normal neurological function and grade 4 indicates coma.

    Measured: At baseline, and at 1, 3, and 6 months after operation

  3. Change of health related quality of life between groups from baseline to 6 months after operation

    A standardized instrument, EuroQoL 5-Dimension 5-Level (EQ-5D-5L) questionnaire, will be used as a generic measure of health related quality of life. The questionnaire contains 5 dimensions: Mobility, Self-Care, Usual Activities, Pain/Discomfort, and Anxiety/Depression. Each dimension rates across five levels, including 'No problems-Slight problems-Moderate problems-Severe problems-Unable to'.

    Measured: At baseline, and at 1, 3, and 6 months after operation

  4. Rate of mortality between groups within 6 months

    Rate of mortality between fixed-time drainage group and exhaustive drainage group

    Measured: From operation up to 6 months postoperatively

  5. Rate of complications and adverse events between groups within 6 months

    Rate of complications and adverse events between fixed-time drainage group and exhaustive drainage group within 6 months

    Measured: From operation up to 6 months postoperatively

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 Oct 2020
  2. Study start29 Dec 2020
  3. Primary completion9 Jul 2024
  4. Study completion15 Dec 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
309 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04573387
Sponsor's protocol ID
KY 2020-094-02
Acronym
ECHO
Status last verified
Dec 2024
First submitted
26 Sep 2020
Last updated
30 Dec 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Ou Y, Yu X, Liu X, Jing Q, Liu B, Liu W. A Comparative Study of Chronic Subdural Hematoma in Patients With and Without Head Trauma: A Retrospective Cross Sectional Study. Front Neurol. 2020 Nov 27;11:588242. doi: 10.3389/fneur.2020.588242. eCollection 2020.

    PubMed 33329333
  • Ou Y, Dong J, Wu L, Xu L, Wang L, Liu B, Li J, Liu W. An Exhaustive Drainage Strategy in Burr-hole Craniostomy for Chronic Subdural Hematoma. World Neurosurg. 2019 Jun;126:e1412-e1420. doi: 10.1016/j.wneu.2019.03.111. Epub 2019 Mar 19.

    PubMed 30902781
  • Ou Y, Dong J, Wu L, Xu L, Wang L, Liu B, Li J, Liu W. The Clinical Characteristics, Treatment, and Outcomes of Chronic Subdural Hematoma in Young Patients. World Neurosurg. 2019 May;125:e1241-e1246. doi: 10.1016/j.wneu.2019.02.017. Epub 2019 Feb 22.

    PubMed 30797913
  • Ou Y, Dong J, Wu L, Xu L, Wang L, Liu B, Li J, Liu W. A comparative study of chronic subdural hematoma in three age ranges: Below 40 years, 41-79 years, and 80 years and older. Clin Neurol Neurosurg. 2019 Mar;178:63-69. doi: 10.1016/j.clineuro.2019.01.018. Epub 2019 Jan 29.

    PubMed 30716602
  • Liu W, Bakker NA, Groen RJ. Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. J Neurosurg. 2014 Sep;121(3):665-73. doi: 10.3171/2014.5.JNS132715. Epub 2014 Jul 4.

    PubMed 24995782
  • Wu L, Ou Y, Liu W. Letter to the Editor. Benefit of postoperative computed tomography in chronic subdural hematoma. J Neurosurg. 2019 Sep 13;131(6):1992-1993. doi: 10.3171/2019.5.JNS191212. Print 2019 Dec 1. No abstract available.

    PubMed 31518980
  • Wu L, Ou Y, Zhu B, Guo X, Yu X, Xu L, Li J, Feng E, Li H, Wang X, Chen H, Sun Z, Liu Z, Yang D, Zhang H, Liu Z, Tang J, Zhao S, Zhang G, Yao J, Ma D, Sun Z, Zhou H, Liu B, Liu W; ECHO Trial Collaborators. Exhaustive drainage versus fixed-time drainage for chronic subdural hematoma after one-burr hole craniostomy (ECHO): study protocol for a multicenter randomized controlled trial. Trials. 2023 Mar 20;24(1):207. doi: 10.1186/s13063-023-07250-y.

    PubMed 36941714

Questions about this trial

What is this clinical trial studying?

A study testing Operation, Fixed-time drainage and Exhaustive drainage in people with Hematoma, Subdural, Chronic, run by Beijing Tiantan Hospital at 17 sites in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 30 Dec 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 17 sites in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Rate of re-operations of chronic subdural hematoma (time frame: From operation up to 6 months postoperatively). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04573387, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Dec 2024.

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