Division of Otolaryngology, Department of Surgery, Zablocki VA Medical Center, Milwaukee, WI, USA.
Int Forum Allergy Rhinol. 2012 Mar-Apr;2(2):95-103. doi: 10.1002/alr.21016. Epub 2012 Jan 17.
Corticosteroids are a mainstay of treatment in the management of sinonasal inflammatory disease. Despite their common use, many practitioners are not well versed in their potential complications or the medico-legal ramifications of their use. The objectives of this review were to outline the existing data of the medico-legal implications of oral steroids.
An OVID database search of the terms "corticosteroids OR adrenal cortex hormones" AND "medico-legal OR malpractice OR jurisprudence OR expert testimony OR informed consent" was performed. This search was then narrowed to English language articles and the titles and abstracts were searched for relevance.
The OVID search identified 178 articles. This search was then narrowed, resulting in 9 articles that were relevant and included in the current review. Five articles involved database reviews of litigation associated with medications. Steroids were found to be a common medication associated with litigation and the cost of the litigation involving steroid use can be very high. Common themes associated with the litigation include poor communication and lack of informed consent regarding steroid use. Several additional articles addressed single cases and many addressed lawsuit prevention.
Lawsuits associated with steroids are disproportionately costly and most of the allegations stem from a lack of informed consent over the use of steroids. Open dialogue with patients is the key to informed consent. Ideally, clinicians should discuss the rationale for steroid use, and the risks, expected benefits, and alternatives of the steroid therapy. Document this discussion and consider providing educational material for the patient to read and review.
皮质类固醇是治疗鼻-鼻窦炎症性疾病的主要药物。尽管它们被广泛应用，但许多医生对其潜在的并发症或使用的法律后果并不熟悉。本综述的目的是概述口服皮质类固醇的法律影响的现有数据。
在 OVID 数据库中使用术语“皮质类固醇或肾上腺皮质激素”和“医疗法律或医疗事故或法理学或专家证词或知情同意”进行检索。然后将搜索范围缩小到英语文章，并搜索标题和摘要以确定相关性。
OVID 搜索确定了 178 篇文章。然后对搜索进行了限制，最终有 9 篇相关文章被纳入本综述。其中 5 篇文章涉及与药物相关的诉讼数据库综述。皮质类固醇是与诉讼相关的常见药物，涉及皮质类固醇使用的诉讼费用可能非常高。与诉讼相关的常见主题包括沟通不畅和缺乏关于皮质类固醇使用的知情同意。另外还有几篇文章涉及单一案例，许多文章涉及预防诉讼。
与类固醇相关的诉讼费用不成比例地高，大多数指控源于缺乏对使用类固醇的知情同意。与患者进行开诚布公的对话是知情同意的关键。理想情况下，临床医生应该讨论使用类固醇的理由，以及类固醇治疗的风险、预期收益和替代方案。记录这次讨论，并考虑为患者提供教育材料供其阅读和复习。
