Dexamethasone in the treatment of subarachnoid hemorrhage revisited: a comparative analysis of the effect of the total dose on complications and outcome.
The benefit of dexamethasone in aneurysmal subarachnoid hemorrhage (SAH) is unproven. This actual study re-examined the impact on complications and outcome. Two hundred and forty-two patient records were analyzed. Dexamethasone had been prescribed individually. Group A consisted of patients in WFNS-grade I to III that were given at least 12mg/day dexamethasone for at least five days. All other patients in WFNS-grade I to III were assigned to group B. Groups C and D resulted from WFNS-grades IV and V, subdivided according to dexamethasone medication as groups A and B. Hydrocephalus and re-hemorrhage were significantly less frequent in group A than B (19% vs. 37%, P=0.011, and 3% vs. 13%, P=0.037, respectively). Favorable outcomes (Glasgow Outcome Scale, GOS 4 and 5) were more frequent in group A than B (99% vs. 85%; P=0.003). Frequencies of vasospasm and infections did not differ. In groups C and D significant differences were demonstrated for frequencies of hydrocephalus (C: 16%, D: 57%; P=0.006) and complications other than infection (C: 33%, D: 79%; P=0.002). Favorable outcomes were more frequent in group C than D (79% vs. 47%; P=0.046). Frequencies of vasospasm and infections did not differ.
Schürkämper
Manuel
M
Department of Neurosurgery, Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany.
Medele
Ralph
R
Zausinger
Stefan
S
Schmid-Elsaesser
Robert
R
Steiger
Hans Jakob
HJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000188:drug therapy / Q000209:etiology; D002533:Cerebral Angiography / Q000379:methods; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D023261:Glasgow Outcome Scale; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000145:classification / Q000188:drug therapy* / Q000503:physiopathology*; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000188:drug therapy / Q000209:etiology
D005938:Glucocorticoids; D003907:Dexamethasone