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Variation in Corticosteroid Prescribing Practices for Patients With Septic Shock.

Kanupriya Soni1, John S Minturn2, Billie S Davis2

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Variation in corticosteroid use for septic shock exists at both the ICU and physician levels. Multilevel interventions are needed to standardize evidence-based care for patients with septic shock.

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Area of Science:

  • Critical care medicine
  • Clinical pharmacology
  • Health services research

Background:

  • Evidence-based guidelines recommend corticosteroids for vasopressor-dependent septic shock.
  • Variation in clinical practice can impact patient outcomes and healthcare costs.
  • Understanding sources of variation is key to improving evidence uptake in acute care.

Purpose of the Study:

  • To characterize physician-level and ICU-level variation in corticosteroid prescribing for patients with septic shock.
  • To identify factors associated with corticosteroid use in septic shock patients.

Main Methods:

  • Retrospective cohort study of 5322 patients with septic shock across 26 ICUs in a multihospital system (2018-2020).
  • Used electronic health record data to identify corticosteroid administration within 2 days of vasopressor initiation.
  • Employed hierarchical mixed-effects logistic regression to quantify variation across physicians and ICUs.

Main Results:

  • 24.3% of patients received corticosteroids. Median ICU-level use was 21.8%; median physician-level use was 22.0%.
  • ICU-level variation accounted for 16.5% of the differences in corticosteroid administration.
  • Physician-level variation accounted for 10.1% of the differences, after controlling for patient and physician characteristics.

Conclusions:

  • Both ICUs and individual physicians contribute significantly to the variation in corticosteroid use for septic shock.
  • Multilevel interventions targeting both institutional and individual physician practices are necessary to standardize evidence-based care.
  • Addressing practice variation can enhance the consistent application of guidelines for septic shock management.