A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Use of Methylprednisolone Sodium Succinate.
Publication/Presentation Date
9-1-2017
Abstract
INTRODUCTION: The objective of this guideline is to outline the appropriate use of methylprednisolone sodium succinate (MPSS) in patients with acute spinal cord injury (SCI).
METHODS: 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."
RESULTS: 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."
CONCLUSIONS: These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in SCI patients.
Volume
7
Issue
3 Suppl
First Page
203
Last Page
203
ISSN
2192-5682
Published In/Presented At
Fehlings, M. G., Wilson, J. R., Tetreault, L. A., Aarabi, B., Anderson, P., Arnold, P. M., Brodke, D. S., Burns, A. S., Chiba, K., Dettori, J. R., Furlan, J. C., Hawryluk, G., Holly, L. T., Howley, S., Jeji, T., Kalsi-Ryan, S., Kotter, M., Kurpad, S., Kwon, B. K., Marino, R. J., … Harrop, J. S. (2017). A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Use of Methylprednisolone Sodium Succinate. Global spine journal, 7(3 Suppl), 203S–211S. https://doi.org/10.1177/2192568217703085
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
29164025
Department(s)
Administration and Leadership
Document Type
Article