title: Indirect Cost and Harm Attributable to Oral 13-Hour Inpatient Corticosteroid Prophylaxis before Contrast-enhanced CT.
abstract: OBJECTIVE
  To estimate the effect of an oral 13-hour inpatient corticosteroid premedication regimen on length of stay, hospital cost, and hospital-acquired infections (HAIs) by using a combination of real and hypothetical study populations.
  
  
  METHODS
  Institutional review board approval was obtained and informed consent waived for this HIPAA-compliant retrospective study. Inpatients who received an oral 13-hour corticosteroid premedication regimen before contrast material-enhanced CT (n = 1424) from 2008 to 2013 were matched by age, sex, and year when CT was performed to a control cohort (n = 1425) of patients who underwent contrast-enhanced CT without premedication and who had similar rates of 13 comorbid diseases. Length of stay in the hospital and time from admission to CT were compared by using the Mann-Whitney U test. Rates of prospectively reported HAIs were compared by using χ(2) tests. The indirect cost and risk of HAI with premedication were estimated by using published data.
  
  
  RESULTS
  Premedicated inpatients had a significantly longer median length of stay (+25 hours; 158 vs 133 hours, P < .001), a significantly longer median time to CT (+25 hours, 42 vs 17 hours, respectively; P < .001), and a significantly greater risk of HAI (5.1% [72 of 1424] vs 3.1% [44 of 1424], respectively; P = .008) compared with nonpremedicated control subjects. On the basis of these data and existing references, the prolonged length of stay was estimated to result in 0.04 HAI-related deaths and a cost of $159 131 (in U.S. dollars) for each prevented reaction of any severity and 32 HAI-related deaths and a cost of $131 211 400 for each prevented reaction-related death.
  
  
  CONCLUSIONS
  Oral 13-hour inpatient corticosteroid prophylaxis is associated with substantial cost relative to its modest benefit, and may cause more indirect harm than the direct harm that it prevents.
authors.affiliation: From the Department of Radiology (M.S.D., B.M.M., .H.E., J.R.D., N.R.D., R.H.C.), Division of Abdominal Imaging (M.S.D., J.H.E., N.R.D., R.H.C.); Section of Pediatric Imaging (J.R.D.), and Michigan Radiology Quality Collaborative (M.S.D.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48108.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Davenport
authors.affiliation: From the Department of Radiology (M.S.D., B.M.M., .H.E., J.R.D., N.R.D., R.H.C.), Division of Abdominal Imaging (M.S.D., J.H.E., N.R.D., R.H.C.); Section of Pediatric Imaging (J.R.D.), and Michigan Radiology Quality Collaborative (M.S.D.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48108.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Mervak
authors.affiliation: From the Department of Radiology (M.S.D., B.M.M., .H.E., J.R.D., N.R.D., R.H.C.), Division of Abdominal Imaging (M.S.D., J.H.E., N.R.D., R.H.C.); Section of Pediatric Imaging (J.R.D.), and Michigan Radiology Quality Collaborative (M.S.D.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48108.
authors.forename: James H
authors.initials: JH
authors.lastname: Ellis
authors.affiliation: From the Department of Radiology (M.S.D., B.M.M., .H.E., J.R.D., N.R.D., R.H.C.), Division of Abdominal Imaging (M.S.D., J.H.E., N.R.D., R.H.C.); Section of Pediatric Imaging (J.R.D.), and Michigan Radiology Quality Collaborative (M.S.D.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48108.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Dillman
authors.affiliation: From the Department of Radiology (M.S.D., B.M.M., .H.E., J.R.D., N.R.D., R.H.C.), Division of Abdominal Imaging (M.S.D., J.H.E., N.R.D., R.H.C.); Section of Pediatric Imaging (J.R.D.), and Michigan Radiology Quality Collaborative (M.S.D.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48108.
authors.forename: N Reed
authors.initials: NR
authors.lastname: Dunnick
authors.affiliation: From the Department of Radiology (M.S.D., B.M.M., .H.E., J.R.D., N.R.D., R.H.C.), Division of Abdominal Imaging (M.S.D., J.H.E., N.R.D., R.H.C.); Section of Pediatric Imaging (J.R.D.), and Michigan Radiology Quality Collaborative (M.S.D.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48108.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Cohan
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011292:Premedication; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D000305:Adrenal Cortex Hormones; D003287:Contrast Media