Provider views on perioperative steroid use for patients with newly diagnosed pediatric brain tumors.

Abstract

PURPOSE:

Cerebral edema from brain tumors can cause neurological impairment. Steroids treat edema but with possible adverse effects. We surveyed providers regarding steroid use in newly diagnosed patients with brain tumors to determine if practices are standard or markedly variable.

METHODS:

An anonymous voluntary online survey was sent to members of neuro-oncology consortiums. Four clinical scenarios were provided and questions regarding initiation of steroids, type, dose, formulation, and duration were asked. Demographic information was collected.

RESULTS:

369 providers received the survey, 76 responded (20.6% response rate). The proportion of providers who would start steroids significantly differed among scenarios (scenario 1 vs 2, p < 0.001; 2 vs 3, p < 0.001; 1 vs 3, p < 0.001). 75 (98.7%) providers would start steroids for vasogenic edema (scenario 1) and 55 (72.4%) for obstructive hydrocephalus (scenario 2). 16 (21.1%) would start steroids for vasogenic edema but not obstructive hydrocephalus. The odds of choosing to start steroids in patients with obstructive hydrocephalus were 7.59 times more (95% CI: 2.29, 25.13) if providers felt symptoms would improve within 24 h. All would use dexamethasone. A significant difference was seen between the proportion of providers who would give a loading dose if vasogenic edema with neurological deficits were noted versus vasogenic edema alone (57.9% vs 43.4%; p = 0.002).

CONCLUSIONS:

These results suggest that providers recommend dexamethasone for patients with vasogenic edema and obstructive hydrocephalus. Variability remains with dosing schedule. Further studies are needed to identify the most appropriate use of steroids for newly diagnosed CNS tumor patients with the goal to create steroid management guidelines.

• Authors: Fatema Malbari, Kristen A Staggers, Charles G Minard, Howard L Weiner, Murali M Chintagumpala, Adam S Levy
• Journal: Journal of neuro-oncology (J Neurooncol) Vol. 147 Issue 1 Pg. 205-212 (Mar 2020) ISSN: 1573-7373 [Electronic] United States
• PMID: 32026434 (Publication Type: Journal Article)

Chemical References

• Steroids
• Dexamethasone

Topics

• Brain Edema (etiology, prevention & control)
• Brain Neoplasms (complications, diagnosis, surgery)
• Dexamethasone (adverse effects)
• Health Personnel
• Humans
• Hydrocephalus (etiology, prevention & control)
• Perioperative Medicine (methods)
• Postoperative Complications (chemically induced)
• Steroids (adverse effects)