Corticosteroids associated with poor outcomes, death in the trauma intensive care unit

February 20, 2006

Patients in the trauma intensive care unit who receive corticosteroids may have more infections, longer stays in intensive care or on a ventilator and a higher death rate than those who do not, according to a study in the February issue of Archives of Surgery, one of the JAMA/Archives journals.

Physicians use corticosteroids in the intensive care unit (ICU) to treat a variety of conditions, including sepsis (systemic blood infection), swelling of the airway and spinal cord injury, according to background information in the article. The medications were first used to treat sepsis in the 1950s and 1960s and evidence has suggested they are effective for this purpose. However, their use suppresses the immune system, leaving patients prone to infections and other complications, the authors write.

Rebecca C. Britt, M.D., of Eastern Virginia Medical School, Norfolk, and colleagues analyzed the records of 100 patients who had received corticosteroids in the trauma-burn ICU at Sentara Norfolk General Hospital between 2002 and 2003. They matched these patients with 100 control patients who were the same age and had injuries of the same severity, but did not receive corticosteroids.

More patients in the corticosteroid group than those in the control group developed pneumonia (26 percent vs. 12 percent), bloodstream infection (19 percent vs. 7 percent) or urinary tract infection (17 percent vs. 8 percent). The rates of these infections did not appear to be related to the type of corticosteroids patients were given or the length of time for which they received them. Patients receiving corticosteroids also stayed in the ICU seven days longer (17.6 vs. 10.2 days) and on a ventilator five additional days (9.9 vs. 4.9 days), and were more likely to die than those who did not.

Many patients in the study had conditions for which use of corticosteroids has not been widely studied. "Thirty-nine of the 100 patients in our study received corticosteroids for an indication supported by the literature," the authors write. "The remaining 61 should not have received corticosteroids based on a strict interpretation of the current literature. Certainly the risk of infection outweighs the potential benefit in these cases." Considering their extra time in the ICU and on a ventilator, those 61 patients also accumulated an additional $717,535.68 in cost because of the corticosteroids, the authors report.

"Caution must be taken to carefully consider the indications, risks and benefits of corticosteroids when deciding on their use," they conclude.
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(Arch Surg. 2006;141:145-149. Available pre-embargo to the media at www.jamamedia.org.)

The JAMA Network Journals

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