前庭神经炎患者的皮质类固醇治疗：急诊科合理和适当护理指南的证据综合。
Corticosteroids for patients with vestibular neuritis: An evidence synthesis for guidelines for reasonable and appropriate care in the emergency department.
机构信息
Department of Emergency Medicine, Hospital de Clinics de Porto Alegre, Porto Alegre, RS, Brazil.
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.
出版信息
Acad Emerg Med. 2023 May;30(5):531-540. doi: 10.1111/acem.14583. Epub 2022 Sep 4.
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.
背景
皮质类固醇短期疗程是专家治疗前庭神经炎 (VN) 时考虑的治疗策略之一。我们进行了伞式综述（系统评价的系统评价），以总结皮质类固醇治疗 VN 的证据。
方法
我们纳入了评估皮质类固醇与安慰剂或常规治疗相比在急性 VN 成年患者中的疗效的随机对照试验 (RCT) 和观察性研究的系统评价。标题、摘要和全文均进行了重复筛选。使用评估系统评价的测量工具 (AMSTAR-2) 工具评估综述的质量。使用推荐评估、制定与评价 (GRADE) 评估来评定证据的确定性。未进行荟萃分析。
结果
从 149 个标题中，选择了 5 个系统评价进行质量评估，其中 2 个评价具有较高的方法学质量并被纳入。这两个综述包括 12 项单独的研究和 660 例 VN 患者。在包括 50 例患者的两项 RCT 的荟萃分析中，皮质类固醇（与安慰剂相比）的使用与更高的完全热恢复相关（风险比 2.81，95%置信区间 [CI] 1.32 至 6.00，低确定性）。由于对患者报告的眩晕或患者报告的头晕残疾等结局的效应估计值不精确，因此尚不确定这是否转化为临床改善。头晕残障评分的结局存在较宽的 CI（一项研究，30 例患者，皮质类固醇组 20.9 分，安慰剂组 15.8 分，平均差值+5.1，95%CI-8.09 至+18.29，极低确定性）。接受皮质类固醇治疗的患者报告的轻微不良反应发生率较高，但该证据的确定性非常低。
结论
有限的证据支持在急诊科使用皮质类固醇治疗 VN。
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