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Emerg Med J doi:10.1136/emermed-2012-202058
  • Original article

Mortality and morbidity after high-dose methylprednisolone treatment in patients with acute cervical spinal cord injury: a propensity-matched analysis using a nationwide administrative database

Open Access
  1. Sakae Tanaka1
  1. 1Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
  2. 2Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  3. 3Department of Medical Informatics and Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  4. 4Department of Health Care Informatics, Tokyo Medical and Dental University, Tokyo, Japan
  1. Correspondence to Dr Hirotaka Chikuda, Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; chikuda-tky{at}umin.ac.jp
  • Received 8 October 2012
  • Revised 18 December 2012
  • Accepted 19 December 2012
  • Published Online First 28 February 2013

Abstract

Objective To examine the magnitude of the adverse impact of high-dose methylprednisolone treatment in patients with acute cervical spinal cord injury (SCI).

Methods We examined the abstracted data from the Japanese Diagnosis Procedure Combination database, and included patients with ICD-10 code S141 who were admitted on an emergency basis between 1 July and 31 December in 2007–2009. The investigation evaluated the patients’ sex, age, comorbidities, Japan Coma Scale, hospital volume and the amount of methylprednisolone administered. One-to-one propensity-score matching between high-dose methylprednisolone group (>5000 mg) and control group was performed to compare the rates of in-hospital death and major complications (sepsis; pneumonia; urinary tract infection; gastrointestinal ulcer/bleeding; and pulmonary embolism).

Results We identified 3508 cervical SCI patients (2652 men and 856 women; mean age, 60.8±18.7 years) including 824 (23.5%) patients who received high-dose methylprednisolone. A propensity-matched analysis with 824 pairs of patients showed a significant increase in the occurrence of gastrointestinal ulcer/bleeding (68/812 vs 31/812; p<0.001) in the high-dose methylprednisolone group. Overall, the high-dose methylprednisolone group demonstrated a significantly higher risk of complications (144/812 vs 96/812;OR, 1.66; 95% CI 1.23 to 2.24; p=0.001) than the control group. There was no significant difference in in-hospital mortality between the high-dose methylprednisolone group and the control group (p=0.884).

Conclusions Patients receiving high-dose methylprednisolone had a significantly increased risk of major complications, in particular, gastrointestinal ulcer/bleeding. However, high-dose methylprednisolone treatment was not associated with any increase in mortality.

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