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Cochrane Database of Systematic Reviews

Corticosteroids for managing tuberculous meningitis

Overview of attention for article published in Cochrane database of systematic reviews, April 2016
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (97th percentile)
  • High Attention Score compared to outputs of the same age and source (88th percentile)

Mentioned by

news
8 news outlets
policy
1 policy source
twitter
34 tweeters
facebook
4 Facebook pages
wikipedia
11 Wikipedia pages

Readers on

mendeley
418 Mendeley
Title
Corticosteroids for managing tuberculous meningitis
Published in
Cochrane database of systematic reviews, April 2016
DOI 10.1002/14651858.cd002244.pub4
Pubmed ID
Authors

Kameshwar Prasad, Mamta B Singh, Hannah Ryan

Abstract

Tuberculous meningitis is a serious form of tuberculosis (TB) that affects the meninges that cover a person's brain and spinal cord. It is associated with high death rates and with disability in people who survive. Corticosteroids have been used as an adjunct to antituberculous drugs to treat people with tuberculous meningitis, but their role has been controversial. To evaluate the effects of corticosteroids as an adjunct to antituberculous treatment on death and severe disability in people with tuberculous meningitis. We searched the Cochrane Infectious Diseases Group Specialized Register up to the 18 March 2016; CENTRAL; MEDLINE; EMBASE; LILACS; and Current Controlled Trials. We also contacted researchers and organizations working in the field, and checked reference lists. Randomized controlled trials that compared corticosteroid plus antituberculous treatment with antituberculous treatment alone in people with clinically diagnosed tuberculous meningitis and included death or disability as outcome measures. We independently assessed search results and methodological quality, and extracted data from the included trials. We analysed the data using risk ratios (RR) with 95% confidence intervals (CIs) and used a fixed-effect model. We performed an intention-to-treat analysis, where we included all participants randomized to treatment in the denominator. This analysis assumes that all participants who were lost to follow-up have good outcomes. We carried out a sensitivity analysis to explore the impact of the missing data. Nine trials that included 1337 participants (with 469 deaths) met the inclusion criteria.At follow-up from three to 18 months, steroids reduce deaths by almost one quarter (RR 0.75, 95% CI 0.65 to 0.87; nine trials, 1337 participants, high quality evidence). Disabling neurological deficit is not common in survivors, and steroids may have little or no effect on this outcome (RR 0.92, 95% CI 0.71 to 1.20; eight trials, 1314 participants, low quality evidence). There was no difference between groups in the incidence of adverse events, which included gastrointestinal bleeding, invasive bacterial infections, hyperglycaemia, and liver dysfunction.One trial followed up participants for five years. The effect on death was no longer apparent at this time-point (RR 0.93, 95% CI 0.78 to 1.12; one trial, 545 participants, moderate quality evidence); and there was no difference in disabling neurological deficit detected (RR 0.91, 95% CI 0.49 to 1.69; one trial, 545 participants, low quality evidence).One trial included human immunodeficiency virus (HIV)-positive people. The stratified analysis by HIV status in this trial showed no heterogeneity, with point estimates for death (RR 0.90, 95% CI 0.67 to 1.20; one trial, 98 participants) and disability (RR 1.23, 95% CI 0.08 to 19.07; one trial, 98 participants) similar to HIV-negative participants in the same trial. Corticosteroids reduce mortality from tuberculous meningitis, at least in the short term.Corticosteroids may have no effect on the number of people who survive tuberculous meningitis with disabling neurological deficit, but this outcome is less common than death, and the CI for the relative effect includes possible harm. However, this small possible harm is unlikely to be quantitatively important when compared to the reduction in mortality.The number of HIV-positive people included in the review is small, so we are not sure if the benefits in terms of reduced mortality are preserved in this group of patients.

Twitter Demographics

The data shown below were collected from the profiles of 34 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 418 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
South Africa 2 <1%
Brazil 1 <1%
Unknown 415 99%

Demographic breakdown

Readers by professional status Count As %
Student > Bachelor 64 15%
Student > Postgraduate 47 11%
Student > Master 47 11%
Researcher 42 10%
Other 40 10%
Other 89 21%
Unknown 89 21%
Readers by discipline Count As %
Medicine and Dentistry 186 44%
Nursing and Health Professions 24 6%
Pharmacology, Toxicology and Pharmaceutical Science 21 5%
Neuroscience 17 4%
Agricultural and Biological Sciences 14 3%
Other 55 13%
Unknown 101 24%

Attention Score in Context

This research output has an Altmetric Attention Score of 85. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 09 November 2021.
All research outputs
#369,479
of 21,084,186 outputs
Outputs from Cochrane database of systematic reviews
#704
of 12,076 outputs
Outputs of similar age
#8,108
of 278,957 outputs
Outputs of similar age from Cochrane database of systematic reviews
#23
of 186 outputs
Altmetric has tracked 21,084,186 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 98th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 12,076 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 28.7. This one has done particularly well, scoring higher than 94% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 278,957 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 97% of its contemporaries.
We're also able to compare this research output to 186 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 88% of its contemporaries.