A Survey of Physician Practices and Knowledge on The Use of Corticosteroids in Pediatrics

Context: Corticosteroids are prescribed for a wide range of medical indications. Comprehensive knowledge is essential to prescribe corticosteroids in an efficient yet safe manner.

Objectives: To explore pediatricians` corticosteroid usage and to compare prescription practices and knowledge among general pediatricians, endocrinologists, and other subspecialists.

Methods: The Pediatricians Corticosteroids Survey, a cross-sectional, nationally representative, web-based survey was disseminated to Israeli pediatricians between February 4th and July 31st, 2018. Survey domains: demographics (9 items), prescription practice (8 items, Cronbach`s α = 0.76) and knowledge (14 items, Cronbach`s α = 0.83).

Results: 349 pediatricians [105 general pediatrician, 207 subspecialists and 37 endocrinologists] completed the survey; 58% had >10 years of pediatric clinical experience and treat on average >60 patients/week; 47.5% prescribed corticosteroids to 10-30% of their patients and 7.5% to >30% of their patients. Corticosteroid knowledge, participants responded `not sure`: 4.1% ‘when tapering of steroids is required`, 8.3% ‘what stress dose refers to`, and 10.1% ‘when stress dose is required`. Multivariate linear analysis showed that higher scores were associated with medical studies in Israel (β=1.059, P=.035), training in pediatric endocrinology (β=2.271, P=.032); medical practice in both general pediatrics + subspeciality (β=2.023, P=.014) and only in a subspeciality (β=1.909, P=.041) compared to general pediatrics alone. Overall, 96.2% thought it would be helpful to participate in continued medical education (CME) sessions.

Conclusions: Our findings suggest that despite vast experience with corticosteroid usage, respondents demonstrated gaps in knowledge for potentially life-threatening situations. Corticosteroid-based CME programs are warranted to improve pediatricians` knowledge and patient health care management.