Pre-existing Corticosteroid Use Predicts Worse Outcomes in Major Trauma

Area of Science:

• Trauma Surgery
• Clinical Pharmacology
• Critical Care Medicine

Background:

• Corticosteroids are widely prescribed for autoimmune and inflammatory conditions.
• Major trauma is a significant cause of mortality, particularly in elderly populations.
• Understanding pre-injury medication effects on trauma outcomes is crucial for patient management.

Purpose of the Study:

• To investigate the association between pre-injury corticosteroid use and clinical outcomes in major trauma patients.
• To identify specific complications linked to corticosteroid use following severe injury.

Main Methods:

• Retrospective analysis of adult patients (≥18 years) admitted to U.S. Level 1 or 2 trauma centers (2019-2021).
• Data sourced from the National Trauma Data Bank.
• Regression analysis adjusted for age, gender, Injury Severity Score (ISS), and Revised Trauma Score (RTS) to assess outcomes including in-hospital mortality.

Main Results:

• Pre-injury corticosteroid use (0.8% of patients) was associated with increased odds of acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), cerebrovascular accident (CVA), and unplanned intubation.
• Corticosteroid use significantly elevated the risk of in-hospital mortality (adjusted odds ratio [aOR] = 1.5, p<0.001).
• Patients with prior steroid use exhibited higher incidences of AKI, ARDS, CVA, unplanned intubation, and mortality compared to non-users.

Conclusions:

• Pre-injury corticosteroid use is a significant predictor of adverse outcomes and increased in-hospital mortality in major trauma patients.
• Healthcare providers should consider pre-existing corticosteroid therapy when managing trauma patients.
• This information is vital for risk stratification and treatment planning in high-risk trauma populations.