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View Full Version : Solu-Medrol vs Solu-Cortef



FFmedic13
09-22-2008, 11:18 AM
The issue regarding the two corticosteroids has been brought up in my service after one of our med bags was restocked by the hospital with solu-medrol (we have always carried solu-cortef). Our state protocols only show solu-medrol for asthma, COPD, and anaphylaxis (well, and decadron as a second option I believe, but i've never used it for anything but spinal cord injury). Solu-cortef is still listed as an approved drug even though it isn't mentioned in the protocol. Our manager isn't concerned and says they're interchangeable, and our medical director just goes off on the tangent about how he isn't convinced that pre-hospital corticosteroids help at all.
For those who have used both, does it make much of a difference which one we use? I realize cost is one factor, but I'm thinking more on the lines of patient outcome.

emt161
09-22-2008, 05:48 PM
I doubt it. Our entire system replaced Solu-Medrol with Solu-Cortef on the idea that the Cortef will do everything the Medrol can do, plus it has benefits for patients with adrenal abnormalities.

As such, Solu-Cortef is now our corticosteroid for asthma, COPD, and anaphylaxis, and it has been added to the Shock protocol for patients with a history of adrenal insufficiency.

DaSharkie
09-23-2008, 09:39 AM
our medical director just goes off on the tangent about how he isn't convinced that pre-hospital corticosteroids help at all.


The use of steroids at all does not do ANYTHING for you or the patient in the field, as it takes a few HOURS for the systemic effects of the medication to really offer any great benefit. They offer more of a benefit in prevention of a flare-up recurring within the next few days of an asthma/COPD flare.

Steroids are great medications, but IV steroids for these situations are no more effective than PO steroids either.

There are studies that do show a correlation to in-hospital stays, mostly due to the wait for many patients to be seen for these situations after arriving at an ED.

It is not a tangent - your medical director is correct.

Scotttt
09-23-2008, 11:00 AM
Although a corticosteroid may not take affect in the prehospital setting, it could considered useful in long-term continuum of care. If it take hours to begin acting on the body, would it be better to have it administered sooner than later? Unfortunately, steroids have been added to the prehospital arsenal in many places without much research into their benefit. The only study I can find that addresses this question is as follows:

Prehosp Emerg Care. 2003 Oct-Dec;7(4):423-6.
The prehospital administration of intravenous methylprednisolone lowers hospital admission rates for moderate to severe asthma.

OBJECTIVE: To compare hospital admission rates for patients with moderate to severe asthma who receive intravenous methylprednisolone given in the prehospital setting versus in the emergency department. METHODS: A retrospective chart review was used to identify emergency medical services (EMS) transports of patients with moderate to severe asthma when 125 mg methylprednisolone was given intravenously in the prehospital setting under existing regional protocols. Data were collected on EMS runs in an urban/suburban system from May 1, 2000, through April 30, 2001. Only patients 18 to 50 years old with a history of asthma were included in the study. Patients were excluded if they left against medical advice, were long-term smokers, used home oxygen, or had a history of chronic obstructive pulmonary disease. A parallel search was performed from February 1, 1999, to April 30, 2000, to identify moderate-severe asthmatics who were transported by EMS and later given intravenous methylprednisolone in the emergency department. During this period, methylprednisolone was not available for use in this EMS system. RESULTS: A total of 31 moderate to severe asthmatics were identified as receiving prehospital methylprednisolone. A total of 33 asthmatics were identified who were transported by EMS and later received intravenous methylprednisolone in the emergency department. Average patient age in the prehospital methylprednisolone group was 34+/-10 years (mean+/-standard deviation; 95% confidence interval [CI]=31-37). Average age in the hospital group was 34+/-10 years (95% CI=31-37). Average time to administration of methylprednisolone in the prehospital setting was 15+/-7 minutes (95% CI=7-22). The average time elapsed in the emergency department before methylprednisolone was 40+/-22 minutes (95% CI=23-57). Only 12.9% (4) of the patients receiving prehospital solumedrol were admitted versus 33.3% (11) of those receiving the medication in the emergency department (p=0.025). Patients were 3.375 times more likely to be admitted if they received methylprednisolone in the emergency department versus in the prehospital setting. CONCLUSION: Patients with moderate to severe asthma who receive intravenous methylprednisolone in the prehospital setting have significantly fewer hospital admissions.

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This study is weak. It's observational and retrospective with a small sample population. I don't have time to further analyze this study to see how they compared the two groups. But, it does, based on the abstract, offer support for their use, even if its only benefit is by way of earlier administration.

DaSharkie
09-24-2008, 07:00 AM
And rarely - if ever - should anyone's practice be altered by 1 single study.

dr-exmedic
09-24-2008, 05:27 PM
And rarely - if ever - should anyone's practice be altered by 1 single study.
Especially one that reports a Confidence Interval for the mean patient age in each group. That's a calculated number, not a statistic, it shouldn't have a 95% CI because you know the exact average age of patients in your study. :rolleyes: But then, Scotttt already noted the study was pretty weak to begin with.