Dexamethasone Therapy in Symptomatic Chronic Subdural Hematoma (DECSA-R): A Retrospective Evaluation of Initial Corticosteroid Therapy versus Primary Surgery
| Autor: | Miah, I.P., Herklots, M., Roks, G., Peul, W.C., Walchenbach, R., Dammers, R., Lingsma, H.F., Hertog, H.M. den, Jellema, K., Gaag, N.A. van der, Dutch Chronic Subdural Hematoma Re |
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| Přispěvatelé: | Neurosurgery, Public Health |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male 030506 rehabilitation medicine.medical_specialty corticosteroid therapy Anti-Inflammatory Agents CSDH Dexamethasone 03 medical and health sciences 0302 clinical medicine Chronic subdural hematoma Modified Rankin Scale Trephining medicine Humans Aged Retrospective Studies Aged 80 and over business.industry Odds ratio Middle Aged Decompression Surgical burr hole craniostomy Surgery Treatment Outcome Corticosteroid therapy chronic subdural hematoma Baseline characteristics Hematoma Subdural Chronic Cohort Drainage Female Neurology (clinical) 0305 other medical science business 030217 neurology & neurosurgery Grading scale medicine.drug |
| Zdroj: | Journal of Neurotrauma Journal of Neurotrauma, 37, 366-372. Mary Ann Liebert Inc. |
| ISSN: | 1557-9042 0897-7151 |
| Popis: | Worldwide, different strategies are being applied for symptomatic chronic subdural hematoma (CSDH). The aim of this study was to evaluate the efficacy of two treatment strategies for symptomatic CSDH: initial dexamethasone (DXM) therapy versus primary surgery by burr hole craniostomy (BHC). We retrospectively collected data for 120 symptomatic CSDH patients in two neurotrauma centers between 2014 and 2016, each with their own treatment protocol. Sixty patients received primary BHC (center A), and another 60 initial DXM therapy (center B). Primary outcome was evaluated by dichotomized modified Rankin Scale (mRS) score (0-3 and 4-6) and Markwalder Grading Scale (MGS) score at 3 months. Secondary outcomes were additional interventions, CSDH recurrence, mortality, complications, and duration of hospital stay. Baseline characteristics were similar in both groups. At 3 months, a favorable mRS score (0-3) was observed in 70% and 76% of patients in cohort A and B, respectively (odds ratio [OR] 0.77, 95% CI 0.30-1.98; p = 0.59). A favorable MGS score (0-1) was observed in 96% of patients in both groups (OR 0.98, 95% CI 0.45-2.15; p = 0.95). CSDH recurrence was 12% in cohort A and 22% in cohort B (p = 0.15). Mortality was 10% in both cohorts. In cohort B, additional surgery was performed in 83% at a median of 6 days, and significantly more patients had complications (55% vs. 35%, p = 0.02), a prolonged hospitalization (10 vs. 5 days; p = 0.02), and one or more follow-up cranial CT's (85% vs. 48%; p |
| Databáze: | OpenAIRE |
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