# Pre-existing Corticosteroid Use Predicts Worse Outcomes in Major Trauma

## TL;DR

Using corticosteroids before major trauma increases the risk of complications and death, according to a study of over 348,000 patients.

## Contribution

This study identifies pre-injury corticosteroid use as a significant predictor of worse clinical outcomes in major trauma patients.

## Key findings

- Corticosteroid use before trauma increases the risk of acute kidney injury, ARDS, and in-hospital mortality.
- Patients on steroids had higher rates of unplanned intubation and cerebrovascular accidents after major trauma.
- Findings suggest providers should consider steroid use when managing trauma patients.

## Abstract

Background and objective

Corticosteroids are one of the most commonly prescribed medications in the United States (U.S.), typically used for their benefits in autoimmune and inflammatory conditions. Major trauma (Injury Severity Score [ISS] >15) is a leading cause of death among young adults and is associated with increased mortality in the elderly population. In this study, we aimed to examine the association between pre-injury corticosteroid use and clinical outcomes in adults experiencing a major trauma event.

Methods

Patients (aged ≥18 years) admitted to U.S. Level 1 or 2 trauma centers for major trauma were selected retrospectively from the National Trauma Data Bank (2019-2021). Regression analysis was employed to determine the association between pre-existing corticosteroid use status and complications, including in-hospital mortality, adjusting for age, gender, ISS, and Revised Trauma Score (RTS).

Results

We identified 348,202 patients, of whom 0.8% (n = 2,733) had prior steroid use; 243,722 were males (70%), and the mean age was 51 years. Steroid use increased the odds of acute kidney injury (AKI) (adjusted odds ratio [aOR] = 1.4, p = 0.011), acute respiratory distress syndrome (ARDS) (aOR = 1.9, p<0.001), cerebrovascular accident (CVA) (aOR = 1.6, p = 0.003), unplanned intubation (aOR = 1.6, p<0.001), and in-hospital mortality (aOR = 1.5, p<0.001). Patients with pre-existing steroid use had a higher incidence of AKI (58 [2.1%] vs. 5,046 [1.5%]), ARDS (31 [1.1%] vs. 2,915 [0.9%]), CVA (41 [1.5%] vs. 2,788 [0.8%]), unplanned intubation (170 [6.3%] vs. 10,886 [3.3%]), and in-hospital mortality (428 [15.7%] vs. 37,014 [11.1%]) compared to their counterparts.

Conclusions

Corticosteroid usage before major trauma is a significant predictor of poorer outcomes and in-hospital mortality. Providers must factor this information into the management of patients on corticosteroid therapy who are at high risk of or have experienced major trauma.