OTA 2005 Posters
Scientific Poster #13 Polytrauma/Injury Prevention
Do Corticosteroids Reduce the Risk of Fat Embolism Syndrome in Multitrauma Patients? A Meta-Analysis
Purpose: This study was conducted to determine the effect of corticosteroids in preventing fat embolism syndrome (FES) in patients with long-bone fractures.
Methods: We searched computerized databases for published randomized controlled studies from 1966 to 2003. We also performed manual searches of major orthopaedic journals, meeting proceedings, and texts. Our main outcome was a clinical diagnosis of FES. Secondary outcomes included hypoxia, petechial rash, mortality, infection, and delayed union. Two investigators independently assessed the quality of each randomized controlled study and extracted the relevant data.
Results: Of the 84 studies identified, 8 were potentially eligible, and only 6 met all our eligibility criteria. From our pooled analysis, we found that corticosteroids reduced the risk of FES by 77% (95%CI; 44% to 91%) and that only 7.4 patients needed to be treated to prevent 1 case of FES. We did not find any significant difference in the rates of mortality, infection, or delayed union.
Conclusions: The current evidence suggests that the use of corticosteroids is warranted in prevention of FES in patients with multiple long-bone fractures. This does not appear to come at the expense of significantly increasing the risk of complications, although a large randomized trial would be needed to confirm this.
Significance: FES is a potentially lethal condition commonly seen in multiply traumatized patients, particularly those with multiple long-bone fractures. Treatment has centered around supportive care and early fracture fixation. Several clinical trials have shown corticosteroids to be beneficial in FES but its use remains controversial. The current meta-analysis suggests that the use of corticosteroids is beneficial in preventing FES.