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Corticosteroids for patients with vestibular neuritis: An evidence synthesis for guidelines for reasonable and appropriate care in the emergency department.
Oliveira J E Silva, Lucas; Khoujah, Danya; Naples, James G; Edlow, Jonathan A; Gerberi, Danielle J; Carpenter, Christopher R; Bellolio, Fernanda.
Afiliação
  • Oliveira J E Silva L; Department of Emergency Medicine, Hospital de Clinics de Porto Alegre, Porto Alegre, RS, Brazil.
  • Khoujah D; Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.
  • Naples JG; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
  • Edlow JA; Division of Otolaryngology-Head & Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
  • Gerberi DJ; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
  • Carpenter CR; Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA.
  • Bellolio F; Department of Emergency Medicine, Washington University at St. Louis, St. Louis, Missouri, USA.
Acad Emerg Med ; 30(5): 531-540, 2023 05.
Article em En | MEDLINE | ID: mdl-35975654
BACKGROUND: A short course of corticosteroids is among the management strategies considered by specialists for the treatment of vestibular neuritis (VN). We conducted an umbrella review (systematic review of systematic reviews) to summarize the evidence of corticosteroids use for the treatment of VN. METHODS: We included systematic reviews of randomized controlled trials (RCTs) and observational studies that evaluated the effects of corticosteroids compared to placebo or usual care in adult patients with acute VN. Titles, abstracts, and full texts were screened in duplicate. The quality of reviews was assessed with the A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) tool. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) assessment was used to rate certainty of evidence. No meta-analysis was performed. RESULTS: From 149 titles, five systematic reviews were selected for quality assessment, and two reviews were of higher methodological quality and were included. These two reviews included 12 individual studies and 660 patients with VN. In a meta-analysis of two RCTs including a total of 50 patients, the use of corticosteroids (compared to placebo) was associated with higher complete caloric recovery (risk ratio 2.81, 95% confidence interval [CI] 1.32 to 6.00, low certainty). It is very uncertain whether this translates into clinical improvement as shown by the imprecise effect estimates for outcomes such as patient-reported vertigo or patient-reported dizziness disability. There was a wide CI for the outcome of dizziness handicap score (one study, 30 patients, 20.9 points in corticosteroids group vs. 15.8 points in placebo, mean difference +5.1, 95% CI -8.09 to +18.29, very low certainty). Higher rates of minor adverse effects for those receiving corticosteroids were reported, but the certainty in this evidence was very low. CONCLUSIONS: There is limited evidence to support the use of corticosteroids for the treatment of VN in the emergency department.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neuronite Vestibular Tipo de estudo: Clinical_trials / Guideline / Observational_studies / Policy_brief / Systematic_reviews Aspecto: Implementation_research Limite: Adult / Humans Idioma: En Revista: Acad Emerg Med Assunto da revista: MEDICINA DE EMERGENCIA Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neuronite Vestibular Tipo de estudo: Clinical_trials / Guideline / Observational_studies / Policy_brief / Systematic_reviews Aspecto: Implementation_research Limite: Adult / Humans Idioma: En Revista: Acad Emerg Med Assunto da revista: MEDICINA DE EMERGENCIA Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos