Idioma:

Do corticosteroids reduce the risk of fat embolism syndrome in patients with long-bone fractures? A meta-analysis

Samuel Bederman, S., MD ; Bhandari, Mohit, MD ; McKee, Michael D., MD ; Schemitsch, Emil H., MD

Canadian Journal of Surgery, 2009-10, Vol.52 (5), p.386-393 [Periódico revisado por pares]

Canada: CMA Impact Inc

Texto completo disponível

Citações Citado por

Enviar para

Título:
Do corticosteroids reduce the risk of fat embolism syndrome in patients with long-bone fractures? A meta-analysis
Autor: Samuel Bederman, S., MD ; Bhandari, Mohit, MD ; McKee, Michael D., MD ; Schemitsch, Emil H., MD
Assuntos: Adrenal Cortex Hormones - therapeutic use ; Care and treatment ; Complications and side effects ; Corticosteroids ; Dosage and administration ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Embolism, Fat - etiology ; Embolism, Fat - mortality ; Embolism, Fat - prevention & control ; Fat embolism ; Female ; Fracture Fixation, Internal - adverse effects ; Fracture Fixation, Internal - methods ; Fracture Healing - physiology ; Fractures ; Fractures, Bone - complications ; Fractures, Bone - diagnosis ; Fractures, Bone - surgery ; Humans ; Male ; Medical disorders ; Meta-analysis ; Postoperative Complications - mortality ; Postoperative Complications - physiopathology ; Prevention ; Prognosis ; Randomized Controlled Trials as Topic ; Risk Assessment ; Risk factors ; Steroids ; Surgery ; Survival Analysis ; Syndrome ; Treatment Outcome
É parte de: Canadian Journal of Surgery, 2009-10, Vol.52 (5), p.386-393
Descrição: Background Fat embolism syndrome (FES) is a potentially lethal condition most commonly seen in polytrauma patients with multiple long-bone fractures. Treatment has centred around supportive care and early fracture fixation. Several small clinical trials have suggested corticosteroids benefit patients with FES, but this treatment remains controversial. Our objective was to determine the effect of corticosteroids in preventing FES in patients with long-bone fractures. Methods We conducted a meta-analysis of published studies of patients with long-bone fractures who were randomly assigned to groups receiving corticosteroids or standard treatment for the prevention of FES (1966–2006). Data were extracted on quality, population, intervention and outcomes. Our primary outcome was the development of FES. We used random-effects models to pool results across studies, assessing for study heterogeneity. Results Of the 104 studies identified, 7 met our eligibility criteria. Overall, the quality of the trials was poor. Our pooled analysis of 389 patients found that corticosteroids reduced the risk of FES by 78% (95% confidence interval [CI] 43%–92%) and that only 8 patients needed to be treated (95% CI 5–13 patients) to prevent 1 case of FES. Similarly, corticosteroids significantly reduced the risk of hypoxia. We found no differences in the rates of mortality or infection. Rates of avascular necrosis were not reported in any of these studies. Conclusion Evidence suggests that corticosteroids may be beneficial in preventing FES and hypoxia but not mortality in patients with long-bone fractures. The risk of infection is not increased with the use of cortisosteroids. However, methodological limitations of these trials necessitate a large confirmatory randomized trial.
Editor: Canada: CMA Impact Inc
Idioma: Francês;Inglês

Links

View this record in MEDLINE/PubMed

Voltar para lista de resultados

Realização: Logos de Redes Sociais:

Do corticosteroids reduce the risk of fat embolism syndrome in patients with long-bone fractures? A meta-analysis

Samuel Bederman, S., MD ; Bhandari, Mohit, MD ; McKee, Michael D., MD ; Schemitsch, Emil H., MD

Canada: CMA Impact Inc

Buscando em bases de dados remotas. Favor aguardar.