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Of medications leading to malpractice claims, corticosteroids comprise the third most common. They are used widely and have a significant side-effect profile: hypertension, lipodystrophy, diabetes, avascular necrosis of the femoral head, peptic ulceration and psychiatric reactions to name but a few. Young et al review the literature relating to the medicolegal issues surrounding the prescription of corticosteroids by otolaryngologists. A total of 14 medicolegal papers across all specialties were identified, of which eight contained cases (n=205) relating to the use of corticosteroids. Of these, only three cases fell within otolaryngology; two cases centred on negligent use, but were decided in favour of the physician. The third case concerned a patient with tuberculosis who had been prescribed corticosteroids to treat an allergic cough, who then died following a pulmonary haemorrhage. The outcome of this case was a $2 million payout to the plaintiff. Despite this paucity of reported medicolegal cases relating to corticosteroid prescribing in otolaryngology, Young et al deduce two key points from their review of the literature: first, and more generally, common causes for successful litigation within ENT include failure/delay of diagnosis and/or treatment (including medication error), intraoperative complications, and inadequate consent and/or provision of information. Secondly, there is a clear, cumulative dose-related development of avascular necrosis of the femoral head, starting from cumulative systemic doses of 430mg Prednisone (or equivalent). Take-home messages from this paper are thus: when wanting to prescribe systemic corticosteroids for ENT conditions, clinicians should not only consider the patient’s past medical history but, importantly, also any prior courses of systemic corticosteroids. The patient can then be counselled appropriately regarding adverse effects of cumulative further doses of systemic corticosteroids, with dosing adjusted as required. Furthermore, taking informed consent should be considered when prescribing corticosteroids. This will facilitate better patient counselling, as well as establishment of a stronger doctor-patient relationship - both are factors linked to lower litigation rates.

Medicolegal Considerations Regarding Steroid Use in Otolaryngology: A Review of the Literature.
Young K, Koshi EJ, Mistakes JC, et at.
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Lucy Dalton

University Hospitals Birmingham, UK.

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