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March 23 2011

Steroids After Severe Injury: Many Unanswered Questions

Author Affiliations

Author Affiliations: Department of Surgery, University of Washington, Seattle.

JAMA. 2011;305(12):1242-1243. doi:10.1001/jama.2011.365

In this issue of JAMA, Roquilly and colleagues1 report the results of the HYPOLYTE (Hydrocortisone Polytraumatise) study, a randomized controlled trial of early hydrocortisone administration to severely injured patients with a primary outcome of hospital-acquired pneumonia within 28 days of injury. All patients were given a short corticotrophin stimulation test, and those meeting their definition of corticosteroid insufficiency continued taking the blinded study treatment, while all other patients had study treatment discontinued. All patients were followed up for the clinical outcomes, and both an intention-to-treat and modified intention-to-treat analysis were conducted. Patients in the hydrocortisone group were found to have significant reduction in pneumonia risk (35.6% vs 51.3%) and a shorter duration of mechanical ventilation (ventilator-free days, 16 days vs 12 days). This study has many strengths including the randomized, placebo-controlled, blinded design, strict definition of the clinical outcome including bronchoalveolar lavage to confirm the diagnosis of pneumonia, and corticotrophin stimulation testing for all patients.