| Title: |
Variation in Corticosteroid Prescribing Practices for Patients With Septic Shock |
| Authors: |
Kanupriya Soni, MD; John S. Minturn; Billie S. Davis, PhD; Leigh A. Bukowski, MPH; Jeremy M. Kahn, MD, MSc; Ian J. Barbash |
| Source: |
Critical Care Explorations, Vol 7, Iss 3, p e1196 (2025) |
| Publisher Information: |
Wolters Kluwer, 2025. |
| Publication Year: |
2025 |
| Collection: |
LCC:Medical emergencies. Critical care. Intensive care. First aid |
| Subject Terms: |
Medical emergencies. Critical care. Intensive care. First aid; RC86-88.9 |
| Description: |
OBJECTIVES:. Understanding sources of variation in acute care delivery may inform targeted strategies to promote evidence-uptake. We sought to characterize physician-level and ICU-level variation in corticosteroid prescribing for patients with septic shock. DESIGN:. We performed a retrospective cohort study using the electronic health record of a multihospital health system. We identified ICU patients with septic shock admitted between 2018 and 2020. Using medication administration data, we determined which patients received corticosteroids within 2 days of vasopressor initiation. We linked each patient to their attending physician of record using digital signatures from clinical documentation. We then fit a hierarchical mixed-effects logistic regression model to identify factors associated with corticosteroid use and quantify variation in corticosteroid administration across physicians and ICUs. SETTING:. Twenty-six ICUs across nine hospitals in the United States. PATIENTS:. ICU patients with septic shock. MEASUREMENTS AND MAIN RESULTS:. Of 5322 patients with vasopressor dependent septic shock, 1294 (24.3%) were treated with corticosteroids within 2 days of vasopressor initiation. We linked these patients to 174 unique attending physicians across 26 ICUs. At the ICU-level, median corticosteroid use was 21.8% (interquartile range [IQR], 18.5–25.7%). At the physician-level, median corticosteroid use was 22.0% (IQR, 11.9–32.7%). In the mixed-effects regression controlling for patient and physician characteristics, 16.5% of the variation in corticosteroid administration was attributable to the ICUs and 10.1% was attributable to the physicians. CONCLUSIONS:. Both ICUs and physicians contribute to observed variation in the use of corticosteroids for vasopressor dependent septic shock. These findings underscore the need for multilevel interventions to standardize evidence-based practices in critical care. |
| Document Type: |
article |
| File Description: |
electronic resource |
| Language: |
English |
| ISSN: |
2639-8028 |
| Relation: |
http://journals.lww.com/10.1097/CCE.0000000000001196; https://doaj.org/toc/2639-8028 |
| DOI: |
10.1097/CCE.0000000000001196 |
| Access URL: |
https://doaj.org/article/ea2d46ff635643c2b01a57ee2a2a84cd |
| Accession Number: |
edsdoj.2d46ff635643c2b01a57ee2a2a84cd |
| Database: |
Directory of Open Access Journals |