Trial of Dexamethasone for Chronic Subdural Hematoma
RCT (n=748) found treatment with dexamethasone resulted in fewer favourable outcomes (83.9% vs. 90.3%, respectively, p=0.01 in favour of placebo) and more adverse events than placebo at 6 months, but fewer repeat operations were performed in the dexamethasone group (1.7 vs. 7.1%)
Source:
New England Journal of Medicine
Resource links:
SPS commentary:
In the study, the primary outcome was a score of 0 to 3, representing a favourable outcome, on the modified Rankin scale at 6 months after randomization; scores range from 0 (no symptoms) to 6 (death).
An editorial notes although the trial answers an important question that has lingered for 50 years by showing no benefit of glucocorticoids with respect to the disability outcome, it is perhaps less certain on the issue of whether glucocorticoids shrink the subdural collection and reduce the need for reoperations. It concludes that the results of this trial reduce the enthusiasm for treating chronic subdural hematomas with glucocorticoids.