Related Experiment Video
Updated: Oct 14, 2025
Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury
Published on: May 27, 2022
Steroid in Chronic Subdural Hematoma: An Updated Systematic Review and Meta-Analysis Post DEX-CSDH Trial
Dhan Bahadur Shrestha1, Pravash Budhathoki2, Yub Raj Sedhai3
1Department of Internal Medicine, Department of Internal Medicine, Mount Sinai Hospital, Chicago, Illinois, USA.
Insights
Steroids may reduce chronic subdural hematoma recurrence but do not improve mortality or success rates. Steroid use also increases adverse events, suggesting caution in their application for CSDH management.
Area of Science:
- Neurology
- Neurosurgery
- Pharmacology
Background:
- Chronic subdural hematoma (CSDH) is a common neurologic condition in the elderly.
- Glucocorticoids, like dexamethasone, are used in CSDH management, alone or with surgery.
Purpose of the Study:
- To conduct an updated systematic review and meta-analysis on the role of steroids in managing CSDH.
- To evaluate the efficacy and safety of steroid treatment for CSDH.
Main Methods:
- Systematic review and meta-analysis of studies up to December 2020.
- Searched PubMed, PubMed Central, Scopus, and Embase databases.
- Analyzed study characteristics, quality, and outcomes using RevMan 5.4.
Main Results:
- Steroid use significantly decreased CSDH recurrence by 61% (OR, 0.39; CI, 0.19-0.79).
- No significant differences were observed in mortality, modified Rankin Scale scores, or treatment success between steroid and control groups.
- Adverse events were 2.7 times more likely in the steroid group (OR, 2.70; CI, 1.71-4.28).
Conclusions:
- Steroid treatment is associated with reduced CSDH recurrence.
- Steroids offer no significant benefit over non-steroid treatments regarding mortality and treatment success.
- Steroid use is linked to a significantly increased risk of adverse events in CSDH patients.
Background:
Chronic subdural hematoma (CSDH) is a neurologic condition characterized as a hematoma in the subdural space with a period >3 weeks that primarily affects the elderly. Glucocorticoid, especially dexamethasone, either alone or combined with surgery, has been used to manage CSDH. We aimed to perform an updated systematic review and meta-analysis of the literature regarding the role of steroids in CSDH.
Methods:
We searched the electronic databases PubMed, PubMed Central, Scopus, and Embase for relevant articles until December 2020. Study characteristics, quality, and end points were extracted, and analysis was performed by RevMan 5.4.
Results:
The odds for subdural hematoma recurrence were decreased by 61% in the steroid group (odds ratio [OR], 0.39; confidence interval [CI], 0.19-0.79) compared with the control group. There was no significant difference in mortality during the study period (OR, 0.66; CI, 0.20-2.18), modified Rankin Scale score 0-3 (OR, 0.87; CI, 0.31-2.40), and modified Rankin Scale score 4-6 (OR, 1.15; CI, 0.42-3.18) between the 2 groups. However, pooling data from 3 studies showed 2.7 times higher odds of occurring adverse effects in steroid groups using the fixed-effect model (OR, 2.70; CI, 1.71-4.28). The treatment success was similar between the steroid and control groups (OR, 2.39; CI, 0.94-6.04).
Conclusions:
Treatment with steroids was associated with a lesser recurrence of CSDH. However, there was no benefit of steroid treatment in CSDH compared with nonsteroid treatment in terms of mortality and treatment success and some but significantly increased risk of adverse events.
