How Dexamethasone Affects Necessity for Surgical Intervention for Chronic Subdural Hematoma: Systematic Review and Meta-Analysis
Notice bibliographique
Résumé
Abstract The effectiveness of dexamethasone in managing chronic subdural hematoma (cSDH) patients remains uncertain although the drug is widely used in this condition. The present systematic review aims to understand the role of dexamethasone in reducing the need for surgery in cSDH patients. This study was conducted as per the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the electronic databases of PubMed, SCOPUS, Cochrane Central Register of Controlled Trials (the Cochrane Library), and ScienceDirect with a predefined search strategy. The population consisted of cSDH patients older than 18 years and treated primarily with dexamethasone. The primary outcome was the need for surgery after dexamethasone therapy in cSDH patients. The meta-analysis of a group of patients was done with the invariance method to estimate the pooled odds of the requirement for surgery after dexamethasone therapy. In the studies with a one-to-one comparison of dexamethasone with placebo/observation, the Mantel–Haenszel statistics were used to determine the odds of surgery. The quality of the studies was assessed with the Newcastle–Ottawa scale (NOS) and the Cochrane risk of bias tool was used to assess the risk of bias in randomized studies. In total, 598 studies were obtained from the database search and after applying the inclusion and exclusion criteria, 10 studies were finally selected for the qualitative and quantitative synthesis. One of the 10 studies was a randomized controlled trial (RCT), while the rest were observational studies. There were 653 patients who received the primary dexamethasone therapy. Of these, 388 patients did not require surgery, while 256 needed surgeries after the therapy. The pooled estimate of requirement for surgery after dexamethasone therapy was 0.41, with a 95% confidence interval of 0.37 to 0.45. A meta-analysis of the one-to-one comparison from three included studies showed a higher need of surgery in the (comparator) placebo/observation group than in the dexamethasone group with odds ratio of 7.16 (95% confidence interval: 2.21–23.13, with p = 0.0001). In addition, we identified the gaps in literature, and the complications and mortality reported in the studies. Dexamethasone is effective in reducing the requirement for surgery in some selected cSDH cases, although many patients still require surgical intervention.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».