Dexamethasone versus Surgery for Chronic Subdural Hematoma | NEJM
In a multicenter, controlled trial, symptomatic patients with chronic subdural hematoma were randomly assigned to receive a 19-day tapering course of dexamethasone or undergo burr-hole drainage. The primary outcome measured was the functional outcome at 3 months, assessed by the modified Rankin scale. A total of 252 patients were enrolled, with 127 in the dexamethasone group and 125 in the surgery group. However, the trial was terminated early due to safety and outcome concerns in the dexamethasone group. Dexamethasone was not found to be noninferior to surgery, with a lower odds ratio for a better score on the modified Rankin scale. The results from secondary endpoints supported the findings of the primary analysis. Complications occurred more frequently in the dexamethasone group (59%) compared to the surgery group (32%), and additional surgery was performed more often in the dexamethasone group (55% versus 6% in the surgery group). In conclusion, dexamethasone treatment for chronic subdural hematoma did not demonstrate noninferiority to burr-hole drainage in terms of functional outcomes and was associated with more complications and a higher likelihood of subsequent surgery.