title: The effect of steroids on the incidence of gastrointestinal hemorrhage after spinal cord injury: a case-controlled study.
abstract: METHODS
  Retrospective case-controlled study.
  
  
  OBJECTIVE
  To understand the incidence of gastrointestinal hemorrhage (GIH) and subsequent mortality rate associated with steroid use after acute spinal cord injury (SCI).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurological Surgery, Lois Pope Life Center, Miami Project to Cure Paralysis, University of Miami MILLER School of Medicine, Miami, FL, USA.
authors.forename: M F
authors.initials: MF
authors.lastname: Khan
authors.affiliation: Department of Neurological Surgery, Lois Pope Life Center, Miami Project to Cure Paralysis, University of Miami MILLER School of Medicine, Miami, FL, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Burks
authors.affiliation: Department of Neuroscience, Dar Al Shifa Hospital, Hawally, Kuwait.
authors.forename: H
authors.initials: H
authors.lastname: Al-Khayat
authors.affiliation: Department of Neurological Surgery, Lois Pope Life Center, Miami Project to Cure Paralysis, University of Miami MILLER School of Medicine, Miami, FL, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Levi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000293:injuries; D002648:Child; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000209:etiology*; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects*; D008875:Middle Aged; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone