Study designs of evaluations included in the review
Only randomised controlled trials were included in the review. Pseudo- or non-randomised trials on less invasive interventions were excluded. All trials of head injuries were excluded as they used either medium doses or extended therapy for more than three days.
Specific interventions included in the review
High-dose methylprednisolone sodium succinate (MPSS). A high dose was defined as an intravenous dose of at least 15 mg/kg or 1 g MPSS given as a single or divided dose over a 3-day period then discontinued.
Participants included in the review
Patients undergoing surgery were included in the review. Studies were excluded if they involved patients who routinely required intensive care at study entry, or were studies of minor operations that were usually performed on an out-patient basis, e.g. oral and facial surgery.
Outcomes assessed in the review
The potential adverse effects assessed were: significant gastrointestinal bleeding, infection, bleeding, leakage or seroma of a wound, pulmonary complications, psychiatric complications, symptomatic avascular bone necrosis proven by X-ray, and death from any cause.
Effectiveness was assessed in terms of pain at rest, fatigue, mobilisation, and hospital stay.
Data on these outcomes were only extracted from trials on pre-operative MPSS administration in elective noncardiac surgery.
How were decisions on the relevance of primary studies made?
The studies were selected by a single reviewer. When there was doubt whether a paper should be included or not, the decision was made by a second investigator who was unaware of the results of the study.