Local injections of corticoid preparations can have serious septic and aseptic complications, according to a new review.

An expert committee for medical malpractice claims of the North Rhine Medical Association (Düsseldorf, Germany) reviewed 1,528 cases of alleged treatment errors relating to injections, identifying 278 cases in which complications arose after local glucocorticosteroid injections at intra-articular, paravertebral, intramuscular, and other sites. The committee found that in 39.6% of cases, treatment errors or patient information errors were involved. The errors included nonmaintenance of aseptic technique; injections performed in the absence of an appropriate indication; time intervals between injections that were too short; excessive dose administration, undiagnosed infections; erroneous injections; that patients were not informed of the risks; and that there were errors of organization and documentation.

The authors concluded that injections of glucocorticosteroids must be performed in strict adherence to the manufacturer’s instructions with respect to the composition of the solution to be injected, the quantity per injection, and the intervals between injections, since repeated injections with too little time between them raise the risk of infection, particularly when deciding on the indication for paravertebral injections. When glucocorticosteroids are injected into small joints and tendon spaces, the introduction of crystals into the subcutaneous tissue and adipose tissue should be avoided. The intramuscular administration of depot glucocorticosteroids should also be avoided. The study was published in the June 15, 2012, issue of Deutsches Arzteblatt International.

“Whenever it is determined that a patient has not given legally valid informed consent for an injection, the physician is liable for any and all adverse consequences of the injection for the patient's health,” concluded lead author Prof. Christian Holland, MD. “By giving physician readers the appropriate knowledge base, the article is intended to help them avoid such difficult medicolegal situations.”

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