TY - JOUR
T1 - The role of corticosteroids in the management of chronic subdural hematomas
T2 - A critically appraised topic
AU - Zarkou, Srijana
AU - Aguilar, Maria I.
AU - Patel, Naresh P.
AU - Wellik, Kay E.
AU - Wingerchuk, Dean M.
AU - Demaerschalk, Bart M.
PY - 2009/9
Y1 - 2009/9
N2 - BACKGROUND: Chronic subdural hematomas (CSDH) occur most commonly in the elderly population. When CSDH patients present with a moderate or severe neurologic deficit and are good surgical candidates, surgery is regarded as the ideal option. However, CSDH patients often have only mild neurologic deficits or are not optimal candidates for surgery. Corticosteroids are often used on these subgroups, but the benefit of this intervention is unknown. Optimal treatment for these patients is not well established. OBJECTIVE: Critically evaluate the role of corticosteroids in the management of CSDH. METHODS: The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario with a structured question, search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and clinical content experts in the fields of vascular neurology and neurosurgery. RESULTS: No randomized controlled trials on the topic were discovered. A prospective cohort study was selected as the best currently available evidence. CONCLUSION: The role of corticosteroids in the management of CSDH is not well defined. Current evidence neither supports nor refutes the use of corticosteroids. A randomized controlled trial is warranted.
AB - BACKGROUND: Chronic subdural hematomas (CSDH) occur most commonly in the elderly population. When CSDH patients present with a moderate or severe neurologic deficit and are good surgical candidates, surgery is regarded as the ideal option. However, CSDH patients often have only mild neurologic deficits or are not optimal candidates for surgery. Corticosteroids are often used on these subgroups, but the benefit of this intervention is unknown. Optimal treatment for these patients is not well established. OBJECTIVE: Critically evaluate the role of corticosteroids in the management of CSDH. METHODS: The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario with a structured question, search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and clinical content experts in the fields of vascular neurology and neurosurgery. RESULTS: No randomized controlled trials on the topic were discovered. A prospective cohort study was selected as the best currently available evidence. CONCLUSION: The role of corticosteroids in the management of CSDH is not well defined. Current evidence neither supports nor refutes the use of corticosteroids. A randomized controlled trial is warranted.
KW - Chronic subdural hematoma
KW - Critically appraised topic
KW - Evidence-based medicine
KW - Glucocorticoids
KW - Nonoperative
KW - Nonsurgical
KW - Steroids
KW - Subdural hematoma
KW - Therapy
UR - http://www.scopus.com/inward/record.url?scp=70349736327&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=70349736327&partnerID=8YFLogxK
U2 - 10.1097/NRL.0b013e3181b65558
DO - 10.1097/NRL.0b013e3181b65558
M3 - Article
C2 - 19741442
AN - SCOPUS:70349736327
SN - 1074-7931
VL - 15
SP - 299
EP - 302
JO - Neurologist
JF - Neurologist
IS - 5
ER -