LAUSR

STUDY DESIGN Retrospective cohort study. OBJECTIVE To evaluate the incidence of litigation due to using or foregoing methylprednisolone, naloxone, or tirilazad for treatment of acute spinal cord injury (ASCI) through querying the Westlaw and VerdictSearch databases. SUMMARY OF BACKGROUND DATA There is historic controversy regarding the use of intravenous steroids for treatment of ASCI. Many highlight that methylprednisolone continues to be used for ASCI treatment mainly as a defensive medicine tactic due to the fear of malpractice litigation. METHODS Westlaw and VerdictSearch were queried for cases involving steroid treatment for ASCI between the years 1998 and 2021. Collected data for each case included year of case hearing, verdict ruling, location of filed claim, and the plaintiff's basis of litigation. Cases were reviewed and categorized by two independent reviewers based on the grievance(s) levied by the plaintiff. Inclusion criteria for topic relevance was defined as a plaintiff's basis of litigation resting on a claim of medical malpractice due to the use, or lack thereof, of methylprednisolone, naloxone, or tirilazad for treatment of ASCI. RESULTS Upon review of 238 cases, case claims were grouped into five categories based on reason for litigation: Social Security benefits (171), lawsuit due to vaccination (25), medical malpractice unrelated to steroid use (16), fungal infections due to methylprednisolone injections (4), and other (22). Zero cases were found to be related to lawsuits filed due to steroid use or lack thereof for ASCI treatment. CONCLUSION Our findings suggest there is limited risk of malpractice litigation due to steroid use or lack thereof in the treatment of acute spinal cord injury. As such, steroid-related treatment decisions for ASCI should be informed by evidence-based approaches to care not influenced by medicolegal concerns.