Takeaway
- Among patients with chronic subdural hematoma (SDH), a course of dexamethasone was associated with a lower rate of favorable outcomes and more adverse outcomes.
- However, placebo was associated in this study with a higher rate of repeat surgery.
Why this matters
- Chronic SDH incidence is increasing.
- The condition recurs in up to 1 in 5 surgically treated patients.
- Few trials have assessed whether dexamethasone is safe or effective.
Key results
- Dexamethasone vs placebo:
- Favorable outcome at 6 months:
- 83.9% vs 90.3%.
- Difference, −6.4 (95% CI, −11.4 to −1.4 percentage points; P=.01);
- OR, 0.55 (95% CI, 0.33-0.91) favoring placebo (P=.02).
- Favorable outcome at 3 months:
- 83.2% vs 91.4%.
- Difference, −8.2 (95% CI, −13.3 to −3.1 percentage points).
- Repeat surgery: 1.7% vs 7.1%.
- Adverse events: OR, 3.4 (95% CI, 1.81-6.85).
- Serious adverse events: 2.49 (95% CI, 1.54-4.15).
- Favorable outcome at 6 months:
Study design
- Multicenter, randomized Dex-CSDH trial (n=680).
- Elderly patients with symptomatic chronic SDH were randomly assigned to a 2-week course of dexamethasone (tapered down from 8 mg twice daily) vs placebo.
- Outcome: favorable 6-month functional outcome per modified Rankin scale.
- Funding: National Institute for Health Research, UK.
Limitations
- Most patients initially underwent surgical evacuation.
- Unclear whether results would have been different in a more conservatively managed cohort.
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