Patients treated with immunosuppressive steroids are less aware of sick day rules Than those on endocrine replacement therapy and may be at greater risk of adrenal crisis

Salehmohamed, Muhammad Ridhwaan; Griffin, Morag; Branigan, Tom; Cuesta, Martín; Thompson, Chris

doi:10.1007/s11845-017-1607-y

Cited by 15 publications

(7 citation statements)

References 17 publications

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“…Awareness of sick day rules is particularly lower in patients taking GCs for immunosuppressive indications compared to those taking them for adrenal hormone replacement therapy [P <0.05]; similar results were seen in a recent study conducted in the United Kingdom where endocrine patients had better awareness as compared to patients taking glucocorticoids for miscellaneous causes [17]. In this study, endocrine patients doubled their steroid dose during inter current illness (89 v/s 23%), obtained parenteral steroid during vomiting (83 v/s 27%), and carried a steroid card (82 v/s 21%), p < 0.001 for all comparisons [17].…”

Section: Discussionsupporting

confidence: 62%

Awareness of sick day rules and use of steroid cards among patients taking long term synthetic oral glucocorticoids for immunosuppression and adrenal hormone replacement at a tertiary hospital in Ethiopia: A cross-sectional study

2022

J Clin Images Med Case Rep

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Background: Glucocorticoids are among the most commonly prescribed medications owing to their generic anti-inflammatory and immunosuppressive effects. Adrenal insufficiency and adrenal crisis are among the major serious adverse effects of long course glucocorticoid treatment. Patient education on sick day rules and the use of steroid treatment identifiers are some of the strategies that are commonly employed to mitigate the risk of AI and adrenal crisis. This study aimed to assess awareness of sick day rules and the use of steroid cards at a tertiary referral hospital in Ethiopia. Methods: A cross-sectional study was conducted at the outpatient medical clinics at Tikur Anbessa Specialized Hospital over a study period of consecutive six months. A total of 100 patients from medical and endocrine clinics who fulfilled the eligibility criteria were recruited to take part in the study on the day they attended their routine follow-up clinics. Interviewer administered questioner regarding sick day rules and use of steroid identifier was used and statistical analysis was done using SPSS software version 20.

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Section: Discussionsupporting

confidence: 62%

Awareness of sick day rules and use of steroid cards among patients taking long term synthetic oral glucocorticoids for immunosuppression and adrenal hormone replacement at a tertiary hospital in Ethiopia: A cross-sectional study

2022

J Clin Images Med Case Rep

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“…Only 81 subscribers were identified as having GCAI, despite GCAI being the most common form of AI in the population. This is consistent with low recognition of this disorder among susceptible patients and the lower rates of AC in GCAI . However, for those patients with past severe AI symptoms associated with missed doses of glucocorticoid, or a past history of an AC, a medical jewellery subscription is prudent.…”

Section: Discussionsupporting

confidence: 61%

The use of medical identification jewellery in adults with adrenal insufficiency in Australia

Rushworth

Chrisp

Torpy

2019

Clinical Endocrinology

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Objective Hydrocortisone stress dosing during illness can prevent adrenal crises (AC) in patients with adrenal insufficiency (AI). When patients cannot communicate, medical identification jewellery may facilitate parenteral hydrocortisone provision but patient adoption rates are not known. Design A cross‐sectional analysis of Australian medical identification jewellery subscription data. Patients Patients with AI aged 20 years and over with an active subscription to a large medical jewellery provider. Measurements Subscription rates by AI subtype, geographic area, age and gender. Results There were 1955 patients with AI and an active subscription in the database, corresponding to a subscription rate of 105.79/million or approximately one‐third of the AI population. The subscription rate was substantially higher in primary AI (60.72/million) than secondary AI (23.16/million), corresponding to approximately 60.7% and 11.6% of the estimated population prevalence of each disorder, respectively. There was substantial variation in use by state/territory, with the highest subscribing state having a rate of over four times that of the lowest (P < 0.001). Women comprised 64.8% (n = 1266) of the group. Subscription also varied by age, being highest in the 60‐69 year age group (165.15/million) and lowest in those aged 30‐39 years (47.23/million) (P < 0.001). Few patients (4.8%, n = 94) mentioned, either in their record or on their jewellery, the need for urgent parenteral hydrocortisone in the event of severe illness. Conclusions Medical jewellery is a component of AC risk reduction. However, subscription appears to be underutilised in the Australian AI population, especially among patients with secondary AI. Urgent treatment recommendations should be inscribed on the jewellery.

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“…Dear Sir or Madam, I write to agree with Salemohammed et al [1] that the sick day rules for corticosteroid cover must be understood by other non-endocrine specialties in the interests of patient safety.…”

mentioning

confidence: 91%

A letter of reply to: Salehmohamed, M.R., Griffin, M., Branigan, T. et al. Patients treated with immunosuppressive steroids are less aware of sick day rules than those on endocrine replacement therapy and may be at greater risk of adrenal crisis. Ir J Med Sci (2017). doi:10.1007/s11845-017-1607-y

Griffin

2017

Ir J Med Sci

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Patients treated with immunosuppressive steroids are less aware of sick day rules Than those on endocrine replacement therapy and may be at greater risk of adrenal crisis

Cited by 15 publications

References 17 publications

Awareness of sick day rules and use of steroid cards among patients taking long term synthetic oral glucocorticoids for immunosuppression and adrenal hormone replacement at a tertiary hospital in Ethiopia: A cross-sectional study

Awareness of sick day rules and use of steroid cards among patients taking long term synthetic oral glucocorticoids for immunosuppression and adrenal hormone replacement at a tertiary hospital in Ethiopia: A cross-sectional study

The use of medical identification jewellery in adults with adrenal insufficiency in Australia

A letter of reply to: Salehmohamed, M.R., Griffin, M., Branigan, T. et al. Patients treated with immunosuppressive steroids are less aware of sick day rules than those on endocrine replacement therapy and may be at greater risk of adrenal crisis. Ir J Med Sci (2017). doi:10.1007/s11845-017-1607-y

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