Dexamethasone Use in Pediatric Neurosurgical Trauma: A Systematic Review of the Current Literature

Introduction: Dexamethasone use in pediatric neurosurgical trauma remains controversial, with varying reports to its overall efficacy. Our study aims to assess the use of dexamethasone in pediatric neurosurgery with regards to patient characteristics, risk factors, and dosing.

Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify literature presenting dexamethasone use in pediatric neurosurgical trauma.

Results: 18 articles including 3 case reports and 15 retrospective studies met our inclusion criteria. Of 766 total patients, there were 172 males (22.5%), 150 females (20.0%), and 444 patients of unmentioned gender. All patients presented with brain injury resulting from various trauma, including falls (96 patients, 12.5%), motor vehicle accidents (129 patients, 16.8%), traumatic brain injury (528 patients, 68.9%), and other sources of trauma in 135 patients (17.6%). CT (622 patients) and MRI (202 patients) imaging were reportedly used for diagnosis. Radiologic findings included fractures and dislocations in 112 patients, brain edema in 496 patients, hematoma/hemorrhage in 56 patients, and enhancing masses in 35 patients. All patients received dexamethasone either prior to, during, after, or in lieu of surgery (72 patients, 9.4%). The clinical indication for dexamethasone use included edema in 502 patients, inflammatory changes in 166 patients, and trauma-associated neurological symptoms in 523 patients. The average dosing of dexamethasone prescribed was 48.0 ± 39.4 mg a day for 5.0 ± 2.0 days. The mean follow-up period was 4.15 ± 3.77 months. At final follow-up, 536 patients reported improvement of initial symptoms, 68 patients reported no change in initial diagnosis, 121 patients reported a decline in initial diagnosis, and 100 patients were deceased. Dexamethasone was reported to improve patient outcomes compared to initial presentation in 96 patients and worsen the patient outcomes in 24 patients.

Conclusion : Our findings suggest that dexamethasone administration in pediatric neurosurgical trauma yields a fourfold increase in the incidence of favorable outcomes relative to adverse reactions.