title: Complications Associated With High-dose Corticosteroid Administration in Children With Spinal Cord Injury.
abstract: BACKGROUND
  Complications with high-dose steroid administration for spinal cord injury are documented in adult patients. Our purpose was to determine the incidence of early complications of this therapy in pediatric patients with spinal cord injuries.
  
  
  METHODS
  An IRB-approved retrospective review was performed for patients treated for spinal cord injury at a level 1 pediatric trauma center between 2003 and 2011. Demographic data, injury characteristics, and surgical interventions were documented. Complications were divided into 4 categories: infectious, gastrointestinal (GI), hyperglycemia/endocrine, and wound healing problems. Complication rates were compared using a Student's t test and Fischer's exact test.
  
  
  RESULTS
  Thirty-four spinal cord injury patients were identified. Twenty-three patients (mean age 6.6 y) in the treatment group received high-dose steroid treatment and 11 patients (mean age 8.4 y) did not and comprised the control group. No statistical difference was detected between the 2 groups regarding age, mechanism of injury, rate of surgical intervention, level of injury, and injury severity. Hyperglycemia was the most common complication and was present in all patients in both the treatment and control groups. The overall infection rate was 64% in the control group compared with 26% in the treatment (P<0.05). The control group demonstrated a significantly increased rate of respiratory tract infections [45% control vs. 9% treatment (P<0.05)]. No surgical patients developed a wound infection. One treatment group patient experienced a GI bleed.
  
  
  CONCLUSIONS
  This is the largest study evaluating the complications associated with high-dose steroid administration for spinal trauma in a pediatric population. Hyperglycemia was found in all spinal cord injury patients, regardless of steroid treatment. Paradoxically, infection rates were noted to be higher in the control group. GI and wound problems were not significantly different. Larger, multicenter prospective studies are needed to better understand the risks in pediatric SCI patients.
authors.affiliation: *Tripler Army Medical Center, Orthopedic Surgery Service, Honolulu, HI †Department of Orthopedics, Texas Scottish Rite Hospital for Children and Children's Medical Center, Dallas, TX ‡Center for Policy & Public Administration, Principal Outcomes Consultant, Draper, UT.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Cage
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Knox
authors.forename: Robert L
authors.initials: RL
authors.lastname: Wimberly
authors.forename: Steve
authors.initials: S
authors.lastname: Shaha
authors.forename: ChanHee
authors.initials: C
authors.lastname: Jo
authors.forename: Anthony I
authors.initials: AI
authors.lastname: Riccio
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000453:epidemiology; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced* / Q000453:epidemiology; D015994:Incidence; D007223:Infant; D007275:Injections, Intravenous; D008297:Male; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000188:drug therapy*; D014193:Trauma Centers; D014481:United States / Q000453:epidemiology
chemical_list: D005938:Glucocorticoids