High-dose steroids for acute spinal cord injury in emergency medical services*1

Bledsoe, Bryan E; Wesley, A. Keith; Salomone, Jeffrey P.

doi:10.1016/j.prehos.2004.03.008

Cited by 5 publications

(2 citation statements)

References 27 publications

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“…[11][12][13]17,18 It is these latter publications, including position statements from three subspecialty organizations that are likely to have facilitated the sharp decrease in steroid administration observed in this study. These publications and the meeting presentations arising from them are also likely responsible for the fact that in 2001 only 30% of spine surgeons felt they understood the steroid literature while five years later 80% do.…”

Section: Figure 4: Perceived Status Of Mp Administration For Sci a Smentioning

confidence: 73%

“…[11][12][13] The conclusions were uniform; Methylprednisolone was to be regarded as a treatment option but not a standard of care. The American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) Joint Section on Disorders of the Spine and Peripheral Nerve went so far as to say that "Treatment with methylprednisolone for either 24 or 48 hours is recommended as an option in the treatment of patients with acute spinal cord injuries that should be undertaken only with the knowledge that the evidence suggesting harmful side effects is more consistent than any suggestion of clinical benefit."…”

mentioning

confidence: 99%

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Methylprednisolone for Acute Spinal Cord Injury: 5-Year Practice Reversal

Hurlbert

Hamilton

2008

Can. j. neurol. sci.

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Steroid administration in the setting of acute spinal cord injury (SCI) became popularized through the 1990's largely as a consequence of the National Acute Spinal Cord Injury Studies (NASCIS) II and III studies, each published in two segments of 6 and 12 month follow-up respectively. [1][2][3][4] However, as health care institutions created and revised protocols for methylprednisolone administration, controversy arose when a number of authors published independent interpretations of the available NASCIS II and III data disputing the conclusions of the NASCIS authors. [5][6][7][8][9] Most criticism questioned claimed statistical significance from arbitrary post-hoc analyses in the absence of clear clinical relevance. Issues were also raised with respect to ABSTRACT: Objective: To re-evaluate practice patterns for methylprednisolone (MP) administration in patients with acute spinal cord injury (SCI) within the spinal surgery community across Canada five years after the publication of practice recommendations. Methods: Canadian orthopedic and neurological spine surgeons were surveyed at their respective annual meetings about their practice of steroid administration for acute SCI by means of a questionnaire comprised of the same seven questions posed five years ago plus an additional question related to change of view. Results: Forty-two surgeons and twenty-one residents directly involved in the acute management of SCI completed the questionnaire. Seventy-six percent of spinal surgeons do not prescribe MP for SCI in sharp contrast to 76% who prescribed it five years ago. Of the 24% who use steroids, the NASCIS II dosing regimen is most commonly followed. One third of physicians continue to administer MP because of fear of litigation. Conclusions: Over a five year period there has been a complete reversal in practice patterns of MP administration for SCI, along with an increased familiarity of the published literature. Attendance at meetings, participation in local group discussions, and peer-reviewed publications appear effective in altering practice preferences arising from peer pressure and even fear of litigation. RÉSUMÉ: La méthylprednisolone dans le traumatisme aigu de la moelle épinière : changement des habitudes de prescription depuis 5 ans.Objectif : L'objectif était de réévaluer les habitudes de pratique des chirurgiens canadiens depuis la publication des recommandations de bonne pratique concernant l'administration de la methylprednisolone (MP) chez les patients qui ont subi une lésion traumatique de la moelle épinière (LTMÉ). Méthodes : Il s'agit d'une enquête effectuée auprès des orthopédistes et des neurochirurgiens lors de leur congrès annuel respectif sur leurs habitudes de prescription de stéroïdes chez les patients qui ont subi une LTMÉ. Le questionnaire comportait sept questions identiques à celles posées il y a cinq ans et une question additionnelle sur le changement d'opinion. Résultats : Quarante-deux chirurgiens et vingt et un résidants directement impliqués dans le traitement de la LTMÉ en ph...

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Section: Figure 4: Perceived Status Of Mp Administration For Sci a Smentioning

confidence: 73%

mentioning

confidence: 99%

Methylprednisolone for Acute Spinal Cord Injury: 5-Year Practice Reversal

Hurlbert

Hamilton

2008

Can. j. neurol. sci.

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Pr�klinisches Management von R�ckenmarkverletzungen

et al. 2005

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In both the United States and Europe about 10,000 patients suffer from spinal cord injury (SCI) each year and 20% die before being admitted to hospital. Prehospital management of SCI is very important since 25% of SCI damage may occur after the initial event. Emergency treatment includes examination of the patient, spinal immobilization, careful airway management, cardiovascular stabilization (maintenance of mean arterial blood pressure above 90 mmHg) and glucose levels within the normal range. From an evidence-based point of view, it is still not known whether additional specific therapy is useful and studies have not convincingly demonstrated that methylprednisolone (MPS) or other substances have clinically important benefits. Recently published statements from the US do not support the therapeutic use of MPS in patients suffering from SCI in the prehospital setting. Moreover, it is not known whether hypothermia or any other pharmacological interventions have beneficial effects. Networks for clinical studies in SCI patients should be established as a basic requirement for further improvement in outcome in these patients.

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Trauma with Neurologic Sequelae

Tennent-Brown¹

2007

Veterinary Clinics of North America: Equine Practice

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High-dose steroids for acute spinal cord injury in emergency medical services*1

Cited by 5 publications

References 27 publications

Methylprednisolone for Acute Spinal Cord Injury: 5-Year Practice Reversal

Methylprednisolone for Acute Spinal Cord Injury: 5-Year Practice Reversal

Pr�klinisches Management von R�ckenmarkverletzungen

Trauma with Neurologic Sequelae

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