Evidence map›Paper›PMID 39562388›Full record

ArticleNeurocritical care2025

A Propensity Score-Weighted Analysis of Short-Term Corticosteroid Therapy for Refractory Pain Following Spontaneous Subarachnoid Hemorrhage.

Adam Kardon, Dowon Kim, Haoyu Ren, Matthew N Jaffa, Dina Elsaesser, Michael Armahizer, Katharina M Busl, Neeraj Badjatia, Gunjan Parikh, Prajwal Ciryam and 3 more

Abstract read
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Article in Neurocritical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Adam KardonProgram in Trauma, Department of Neurology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, 21201, USA. adkardon@gmail.com.ORCID 0000-0001-6595-6722
Dowon KimProgram in Trauma, Department of Neurology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, 21201, USA.
Haoyu RenDepartment of Mathematics and Statistics, University of Maryland, Baltimore County, Baltimore, MD, USA.
Matthew N JaffaDivision of Neurocritical Care, Department of Neurology, Ayer Neuroscience Institute, Hartford Hospital, Hartford, CT, USA.
Dina ElsaesserProgram in Trauma, Department of Neurology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, 21201, USA.
Michael ArmahizerDepartment of Pharmacy Services, University of Maryland Medical Center, Baltimore, MD, USA.
Katharina M BuslDepartments of Neurology and Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA.
Neeraj BadjatiaProgram in Trauma, Department of Neurology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, 21201, USA.
Gunjan ParikhProgram in Trauma, Department of Neurology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, 21201, USA.
Prajwal CiryamProgram in Trauma, Department of Neurology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, 21201, USA.
J Marc SimardDepartment of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Chixiang ChenDepartment of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Nicholas A MorrisProgram in Trauma, Department of Neurology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, 21201, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCorticosteroids are prescribed for refractory headache in patients with spontaneous subarachnoid hemorrhage (SAH) despite limited supporting evidence. We hypothesized that a short course of corticosteroids would reduce pain.

methodsWe reviewed all patients who received corticosteroids for refractory headache following spontaneous SAH within our institutional database. Pain was measured by a numeric rating scale (NRS) every 2 h. The primary outcome was maximum daily NRS score; secondary outcomes were the mean daily NRS score and daily opioid consumption. Propensity scores were developed using potential predictors of corticosteroid use, including age, sex, pretreatment 24-h pain burden, and the number of analgesics being used to control pain. Inverse probability treatment weighting (IPTW) was used to balance baseline covariate distributions between patients receiving corticosteroids and control patients. Generalized estimating equations were used to analyze longitudinal NRS scores and oral morphine equivalents based on the weighted cohort.

resultsA total of 213 patients were included. The mean age was 55 (SD 13) years, and 141 of 213 (66%) were female. Of 213 patients, 195 (92%) had a low clinical grade (i.e., Hunt-Hess grades 1-3). Seventy patients were prescribed corticosteroids on postbleed day 5 (SD 3.3) on average, with an average of 26 (SD 10) mg of dexamethasone over 48 h. Patients receiving corticosteroids and controls were well balanced on baseline predictors of treatment status. After IPTW, we found that corticosteroid therapy reduced the daily maximum pain NRS score by 0.59 (SE = 0.39, p = 0.12), 0.96 (SE = 0.42, p = 0.02), and 0.91 (SE = 0.46, p = 0.048) on days 1-3, respectively, after adjusting for control effects. The mean daily pain NRS score and daily opioid use were nonsignificantly reduced in the 3 days following corticosteroid initiation after adjusting for control effects.

conclusionsShort-term corticosteroids only slightly reduced maximum pain severity after spontaneous SAH. Other analgesic strategies are required to manage refractory pain in this population.

Indexed as

Adrenal Cortex HormonesHeadacheIntractable PainOutcome Assessment, Health CareSubarachnoid HemorrhageAdultAgedAnalgesics, OpioidFemaleHumansMaleMiddle AgedPain MeasurementPropensity ScoreAdrenal Cortex HormonesAnalgesics, OpioidCorticosteroidsHeadachePain managementPropensity scoreSubarachnoid hemorrhage

Identifiers

PMID39562388

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.