Abstract
Study design:
Retrospective case–controlled study.
Objectives:
To understand the incidence of gastrointestinal hemorrhage (GIH) and subsequent mortality rate associated with steroid use after acute spinal cord injury (SCI).
Setting:
Miami, Florida, USA.
Methods:
This case–controlled study investigates two sequential study groups with SCI treated by a single surgeon in a level I trauma center. The first study cohort (1997–2005) received steroids according to the NASCIS II protocol and the second (2005–2012) received no steroid treatment. The groups were comparable with respect to age, sex, severity and level of injury (43 vs 45 years old/3:1 male-female/AIS scale %—43.5 vs 41.7 A, 10.6 vs 11.1 B, 20.3 vs 13.4 C, 25.4 vs 33.5 D/64.3 vs 73.8% cervical, 35.6 vs 25.7% thoracic and lumbar). The incidence and mortality from GIH were the primary outcome measures.
Results:
A total of 350 patients were evaluated during the study period. The incidence of GIH in the SCI group receiving steroids was 6/216 (2.77%) with 2 mortalities (33.3%). No gastrointestinal (GI) complications were noted in the 134 patients that did not receive any steroids (P=0.086). All GIH cases in the steroid group were in cervical SCI patients—6/139 (4.32%; P=0.043). Average time to onset of GIH was 16 days.
Conclusion:
The use of steroids in acute SCI appears to be a key risk factor in increasing the incidence of clinically overt GI complications with a subsequent high mortality rate, particularly in patients with cervical SCI.
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Acknowledgements
We thank the Miami Project to Cure Paralysis and the University of Miami Miller School of Medicine for their facilities. We also thank Enmanuel Perez Martinez for his valuable suggestions.
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Khan, M., Burks, S., Al-Khayat, H. et al. The effect of steroids on the incidence of gastrointestinal hemorrhage after spinal cord injury: a case–controlled study. Spinal Cord 52, 58–60 (2014). https://doi.org/10.1038/sc.2013.122
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DOI: https://doi.org/10.1038/sc.2013.122
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