For February 2021, we have selected: Hutchinson P.J. et al. Trial of Dexamethasone for Chronic Subdural Hematoma. N Engl J Med. 2020. PMID: 33326713 Clinical Trial.
Our research study of the month is multicentre, randomised trial from the UK investigating the clinical outcome of dexamethasone in adult patients with symptomatic chronic subdural hematoma. Although it is commonly used in clinical practice in this group of patients, the clinical benefit has never been systematically studied.
From August 2015 through November 2019, 748 patients were randomly assigned in a 1:1 ratio to oral dexamethasone (8 mg twice a day in a 2 week tapering course) or placebo. 680 patients completed the complete duration of the trial.
The primary outcome was based on the Rankin scale score at 6 months follow up after enrolment. 60% of participants in both groups had a score of 1 to 3 on the modified Rankin scale at admission and 94% underwent surgery to evacuate their hematomas.
A Rankin scale score up to 3 (indicating a favourable outcome) was reported in 286 of 341 patients (83.9%) in the dexamethasone group and in 306 of 339 patients (90.3%) in the placebo group with a statistically significant difference between the two groups (P = 0.01).
However, recurrence of haematoma requiring second surgery was recorded in 6 of 349 patients (1.7%) in the dexamethasone group and in 25 of 350 patients (7.1%) in the placebo group. Adverse events occurred mainly in the dexamethasone group.
Overall, the authors of our paper of the month concluded that, whilst dexamethasone might be considered a preventive factor for recurrence of heamatoma, it is not associated with a final favourable outcome and is associated with more adverse events. More studies involving centres from different countries might be useful to investigate further the use of this medication in subdural haematoma.