Early neurological care of patients with spinal cord injury

Kessler, Thomas M.; Traini, Luca R.; Welk, Blayne; Schneider, Marc P.; Thavaseelan, Jeffrey; Curt, Armin

doi:10.1007/s00345-018-2343-2

Cited by 14 publications

(9 citation statements)

References 26 publications

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“…Most of the recommendations had a low evidence base (n=9). Clinicians must begin lowmolecular-weight heparin/unfractionated heparin early after SCI, when there is no contraindication (Kessler et al, 2018) Level 1 High…”

Section: Management Of Hemostasismentioning

confidence: 99%

“…For major trauma patients, use lowdose unfractionated heparin, lowmolecular heparin, or mechanical prophylaxis, preferably with intermittent pneumatic compression, over no prophylaxis (Gould et al, 2012) High -Low High-Low Chemical venous thromboembolism (VTE) prophylaxis, with unfractionated heparin, should be initiated within 24 hours of injury (Birrer et al, 2018) Class Clinicians must consider compression devices to prevent VTE after SCI (Kessler et al, 2018) Level 1 High…”

Section: Management Of Hemostasismentioning

confidence: 99%

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A Scoping Review of Clinical Practice Guidelines for the Acute Care of Patients with Spinal Cord Injury: Respiratory, Hemodynamic and Neuroprotective Management

Gregorio¹,

Manhas²,

Brehon³

et al. 2023

IJCC

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Background: Given the complex nature of acute SCI management, there is a pressing need to review and evaluate existing clinical practice guidelines (CPGs). This study aims to evaluate CPGs and create a summary of recommendations related to the in-hospital acute management of SCI in three different areas: respiratory management, hemodynamic management and the use of neuroprotective agents. Method: This study was conducted in accordance with the guidelines set by the Joanna Briggs Institute, and PRISMA-ScR. A search was conducted in thirteen databases and the gray literature. Screening and data extraction was completed by two independent reviewers against pre-specified eligibility criteria. The AGREE II tool was used to appraise the quality of the CPGs. Results: The search identified 12 eligible studies. Seven (n=7) studies were published in the last five years. Overall, the recommendations were supported by low quality evidence. Based on the AGREE II quality appraisal, seven out of twelve CPGs can be recommended for use, and one can be recommended with modification. The following domains scored the highest average score: “Clarity of Presentation,” “Scope and Purpose,” and “Editorial Independence.” Domain 5 “Applicability” and domain 2 “Stakeholder Involvement” scored the lowest average score. While the majority of the recommendations were consistent, there were contradicting recommendations concerning the use of methylprednisolone. Conclusion: The CPGs in the management of acute SCI are overall based on low-quality evidence. More evidence is needed to recommend for or against the use of methylprednisolone in acute SCI patients. Indeed, there is a need for the development of rigorous and up-to-date CPGs that is based on high-quality evidence.

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Section: Management Of Hemostasismentioning

confidence: 99%

Section: Management Of Hemostasismentioning

confidence: 99%

A Scoping Review of Clinical Practice Guidelines for the Acute Care of Patients with Spinal Cord Injury: Respiratory, Hemodynamic and Neuroprotective Management

Gregorio¹,

Manhas²,

Brehon³

et al. 2023

IJCC

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“…Unfractionated heparin should be used for cases where LMWH is not available or contraindicated. 19 In the patients that require surgical treatment, LMWH must be suspended 12 hours before the programmed surgery and restarted in the 24 hours posterior to the surgery. 20 The recommended duration of thromboprophylaxis is 3 months.…”

Section: Venous Thromboembolic Disease Prophylaxismentioning

confidence: 99%

Untitled

2020

Indian Journal of Neurotrauma

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Spinal cord trauma constitutes one of the main causes of mortality and morbidity in young adults around the world, with an estimated 2 to 3 new cases for every 100,000 population. Road traffic accidents, falls from high heights, sports injuries, and violent actions are common causes of spinal cord injuries. There is no "gold standard" for the diagnosis of spinal cord traumatic injuries; however, the rational use of conventional radiologic test, computed tomography scan, and magnetic resonance imaging (MRI) will allow to identify almost all clinically relevant injuries. MRI is recommended according to surgeon's criteria, who after evaluating the specific characteristics of the injury will determine its usefulness. Therapeutic strategies need to be directed to maintain airway, breathing and circulation, maintenance of mean arterial pressure prevention of hypotension, and assessment of other associated injuries. Intensive treatment must be focused on the prevention and management of ventilatory and cardiovascular abnormalities related to muscle weakness and loss of autonomic innervation.

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“…There is strong evidence that SCI rehabilitation both in the acute and long-term phase can enhance recovery, reduce complications, and improve community reintegration. 2 An excellent resource summarizing this evidence is The Spinal Cord Injury Research Evidence (SCIRE) project. 3 However, in developing countries SCI rehabilitation is either non-existent, poorly developed or not accessible to most of the patients with SCI in need of these services.…”

mentioning

confidence: 99%

The Impact of Interdisciplinary Spinal Cord Injury Rehabilitation on Improving Neurological Outcomes

Rathore¹,

Arif

2021

Global Spine Journal

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We have read the article "Timing of surgery in thoracolumbar spine injury: Impact on neurological outcome" by Qadir at.al 1 with interest. It is an important study addressing several key issues in the early surgical management of acute thoracolumbar Spinal Cord injury (SCI) management and its impact on the neurological recovery at 12 months.Based on our experience of providing rehabilitation services to SCI patients in a variety of settings across the country, we would like to offer some comments and suggestions regarding the role of early and coordinated multi-disciplinary SCI rehabilitation. There is strong evidence that SCI rehabilitation both in the acute and long-term phase can enhance recovery, reduce complications, and improve community reintegration. 2 An excellent resource summarizing this evidence is The Spinal Cord Injury Research Evidence (SCIRE) project. 3 However, in developing countries SCI rehabilitation is either nonexistent, poorly developed or not accessible to most of the patients with SCI in need of these services. 4,5 This can have adverse effects on the patients with SCI even if they are provided early spinal surgery. This was highlighted during the Oct 2005 earthquake in Pakistan which resulted in hundreds of acute SCI patients. Many of these patients underwent spinal surgery even though most of them had a complete injury. Due to the lack of SCI rehabilitation services at that time many of them could not be managed in specialized SCI rehabilitation centers. 6 Those who were under rehabilitation care had better outcomes and reduced complications at follow-up. 7,8 Unfortunately, after 15 years things have not changed much for patients with SCI in Pakistan. Most of the patients with traumatic SCI in Pakistan are operated upon by the spinal and neurosurgeons and discharged to home without any formal rehabilitation consultation or a long-term plan. Rehabilitation is confused with physiotherapy and some form of exercises alone. 8 Physicians, Surgeons and the public are not clear about the concept of a multi-disciplinary rehabilitation. As a result, surgeons, patients, and the caregivers consider physiotherapy as the only form of SCI rehabilitation. This results in neglect of

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Early neurological care of patients with spinal cord injury

Abstract: Early treatment, prevention of associated complications and individualized patient-targeted rehabilitation programs provided by a specialized interdisciplinary team are crucial to optimize the outcome after SCI.

Cited by 14 publications

References 26 publications

A Scoping Review of Clinical Practice Guidelines for the Acute Care of Patients with Spinal Cord Injury: Respiratory, Hemodynamic and Neuroprotective Management

A Scoping Review of Clinical Practice Guidelines for the Acute Care of Patients with Spinal Cord Injury: Respiratory, Hemodynamic and Neuroprotective Management

Untitled

The Impact of Interdisciplinary Spinal Cord Injury Rehabilitation on Improving Neurological Outcomes

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