Pre-existing Corticosteroid Use Predicts Worse Outcomes in Major Trauma

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.