EMOttawa - March 1, 2016
"Steroids have been used in medicine for their immune-modulating effects for decades, but how much of their use is actually evidence based? Here we review the most recent literature for their use in four select presentations often seen in the Emergency Department (ED).
Steroids in biphasic anaphylaxis
- Bottom Line:
- There is no evidence supporting the use of steroids given in the ED to prevent biphasic anaphylaxis; however, steroids continue to be suggested as an adjunct on guidelines, and should be considered in patients who experience more severe initial reactions. There is also no evidence to support prescribing outpatient steroids after an anaphylactic reaction.
Steroids in sepsis
- Bottom Line:
- Steroids may favourably impact all-cause mortality at 28 days in patients with sepsis, but there are significant limitations to this evidence.
- If given, it should be given at low dose (≤400mg hydrocortisone or equivalent) for ≥3 days at full dose.
- The ADRENAL study is in progress, and will be the largest study to examine steroids in sepsis.
Steroids in pneumonia
- Bottom line:
- In patients admitted with severe community-acquired pneumonia, steroids are worth considering given the potential to reduce hospital length of stay.
- However, this benefit should be carefully weighed in patients susceptible to the side effects of steroids (hyperglycemia).
Steroids in lumbosacral radiculopathy
- Bottom line:
- With very strict inclusion criteria, this study demonstrates a potential benefit for steroid utilization in a small subset of patients.
- More research is required, with a focus on improvement of disability and function in patients, rather than pain improvement scores"