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Corticosteroid Complications From Use in Acute Pediatric Spinal Cord Injuries
Michelle C. Caruso, PharmD, BCPS, Margot Daugherty, MSN, MEd, RN, CEN, Suzanne Moody, MPA, CCRP, Richard A. Falcone, Jr., MD, MPH, Karin Bierbrauer, MD, and Gary L. Geis, MD, Cincinnati Children's Hospital Medical Center, Cincinnati OH

Abstract: Purpose: Methylprednisolone sodium succinate (MPSS) has been studied as a pharmacologic adjunct that may be given post-acute spinal cord injury (ASCI) to improve neurologic recovery. MPSS became standard of care in adults despite lack of evidence supporting clinical benefit. More recently, new guidelines from neurological surgeon groups recommended no longer using MPSS for ASCI, due to questionable clinical benefit and known complications. However, little information exists in the pediatric population regarding side effects. We intend to describe steroid use and side effects in ASCI at our level 1 pediatric trauma center to inform other hospitals which may still use this therapy. Methods: A retrospective chart review was conducted to determine frequency and types of complications in the pediatric ASCI population treated with steroids. Inclusion criteria included age < 21, blunt trauma, physician concern for ASCI and admission for ≥ 24 hours or received high-dose intravenous methylprednisolone, dexamethasone, or hydrocortisone. Exclusion criteria included penetrating trauma, no documentation of ASCI, and incomplete medical records. Charts were reviewed for a predetermined list of complications. Results: Five hundred seventy-two charts were reviewed; 338 patients were included. In patients receiving steroids, 47% (31/66) experienced complications compared with 18% (48/272) in patients not receiving steroids (p <0.0000). Range was 1-8 complications in the steroid group; 1-4 complications in the non-steroid group. The most common complications were nausea/vomiting and fever in both groups, plus hyperglycemia in the steroid group. Conclusions: Patients receiving steroids for pediatric ASCI were significantly more likely to experience complications than patients not receiving steroids.

Objective: Describe two reasons why high-dose steroids should not be used in acute pediatric spinal cord injuries.

Objective Content: Purpose: Methylprednisolone sodium succinate (MPSS) has been studied as a pharmacologic adjunct that may be given post-acute spinal cord injury (ASCI) to improve neurologic recovery. MPSS became standard of care in adults despite lack of evidence supporting clinical benefit. More recently, new guidelines from neurological surgeon groups recommended no longer using MPSS for ASCI, due to questionable clinical benefit and known complications. However, little information exists in the pediatric population regarding side effects. We intend to describe steroid use and side effects in ASCI at our level 1 pediatric trauma center to inform other hospitals which may still use this therapy.


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