Comparative efficacy of dexamethasone versus surgery for chronic subdural hematoma: A systematic review and meta-analysis

医学 地塞米松 入射(几何) 荟萃分析 慢性硬膜下血肿 相对风险 观察研究 内科学 外科 随机对照试验 血肿 置信区间 光学 物理
作者
Areeba Shoaib,Fariha Arif,Maryam Khan,Tehreem Fatima,Shayan Marsia
出处
期刊:Clinical Neurology and Neurosurgery [Elsevier BV]
卷期号:241: 108288-108288
标识
DOI:10.1016/j.clineuro.2024.108288
摘要

To assess the comparative efficacy of dexamethasone (DXM) as monotherapy in comparison to surgery among the patients of chronic subdural hematoma (CSDH). We searched MEDLINE, PUBMED, EMBASE, and Cochrane Central Register of Controlled Trials databases from inception till September 2023. Data was extracted, pooled and analyzed from all the studies that assessed the comparative efficacy of DXM as monotherapy in contrast with surgery as the primary treatment of CSDH. A total of 6 studies involving 704 patients were included in our meta-analysis. Comparison of surgery to DXM revealed there was no statistically significant difference between the two groups regarding mortality [RR=1.09; 95% CI; 0.52–2.28 P = 0.83]. However, a significantly higher incidence of secondary surgical intervention was observed in the DXM group [RR 4.24; 95% CI; 2.06-8.71 P < 0.0001]. No significant difference in performance was observed in terms of poor postoperative outcomes within hospital stay [RR 1.12, 95% CI, 0.40-3.19 P=0.83] and at 6 months [RR 0.92, 95%CI, 0.40-2.13 P=0.85]. DXM had a significantly higher incidence of secondary surgical intervention. However, there was no difference regarding mortality and other safety outcomes between surgery and DXM for the patients with CSDH. Observational studies showed that DXM was associated with a lower risk of poor postoperative outcomes within hospital stay and had shorter duration of hospital stay, but the recurrence rate was lower in the surgery group.
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