A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Use of Methylprednisolone Sodium Succinate
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- Michael G. Fehlings
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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- Jefferson R. Wilson
- University of Toronto, Toronto, Ontario, Canada
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- Lindsay A. Tetreault
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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- Bizhan Aarabi
- University of Maryland, Baltimore, MD, USA
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- Paul Anderson
- University of Wisconsin, Madison, WI, USA
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- Paul M. Arnold
- University of Kansas Medical Center, The University of Kansas, Kansas City, KS, USA
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- Darrel S. Brodke
- University of Utah, Salt Lake City, UT, USA
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- Anthony S. Burns
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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- Kazuhiro Chiba
- National Defense Medical College, Saitama, Japan
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- Joseph R. Dettori
- Spectrum Research, Inc, Tacoma, WA, USA
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- Julio C. Furlan
- University of Toronto, Toronto, Ontario, Canada
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- Gregory Hawryluk
- University of Utah, Salt Lake City, UT, USA
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- Langston T. Holly
- University of California at Los Angeles, CA, USA
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- Susan Howley
- Christopher & Dana Reeve Foundation, Short Hills, NJ, USA
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- Tara Jeji
- Ontario Neurotrauma Foundation, Toronto, Ontario, Canada
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- Sukhvinder Kalsi-Ryan
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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- Mark Kotter
- University of Cambridge, Cambridge, England
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- Shekar Kurpad
- Medical College of Wisconsin, Milwaukee, WI, USA
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- Brian K. Kwon
- University of British Columbia, Vancouver, British Columbia, Canada
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- Ralph J. Marino
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
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- Allan R. Martin
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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- Eric Massicotte
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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- Geno Merli
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
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- James W. Middleton
- University of Sydney, Sydney, New South Wales, Australia
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- Hiroaki Nakashima
- Nagoya University, Nagoya, Japan
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- Narihito Nagoshi
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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- Katherine Palmieri
- The University of Kansas, Kansas City, KS, USA
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- Andrea C. Skelly
- Spectrum Research, Inc, Tacoma, WA, USA
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- Anoushka Singh
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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- Eve C. Tsai
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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- Alexander Vaccaro
- Thomas Jefferson University, Philadelphia, PA, USA
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- Albert Yee
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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- James S. Harrop
- Thomas Jefferson University, Philadelphia, PA, USA
Description
<jats:sec><jats:title>Introduction:</jats:title><jats:p> The objective of this guideline is to outline the appropriate use of methylprednisolone sodium succinate (MPSS) in patients with acute spinal cord injury (SCI). </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> A systematic review of the literature was conducted to address key questions related to the use of MPSS in acute SCI. A multidisciplinary Guideline Development Group used this information, in combination with their clinical expertise, to develop recommendations for the use of MPSS. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> The main conclusions from the systematic review included the following: (1) there were no differences in motor score change at any time point in patients treated with MPSS compared to those not receiving steroids; (2) when MPSS was administered within 8 hours of injury, pooled results at 6- and 12-months indicated modest improvements in mean motor scores in the MPSS group compared with the control group; and (3) there was no statistical difference between treatment groups in the risk of complications. Our recommendations were: (1) “We suggest not offering a 24-hour infusion of high-dose MPSS to adult patients who present after 8 hours with acute SCI”; (2) “We suggest a 24-hour infusion of high-dose MPSS be offered to adult patients within 8 hours of acute SCI as a treatment option”; and (3) “We suggest not offering a 48-hour infusion of high-dose MPSS to adult patients with acute SCI.” </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in SCI patients. </jats:p></jats:sec>
Journal
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- Global Spine Journal
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Global Spine Journal 7 (3_suppl), 203S-211S, 2017-09
SAGE Publications
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Details 詳細情報について
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- CRID
- 1360846643870913408
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- ISSN
- 21925690
- 21925682
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- Data Source
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- Crossref
- KAKEN