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    A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome Prediction

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    Author
    Fehlings, M.G.
    Martin, A.R.
    Tetreault, L.A.
    Date
    2017
    Journal
    Global Spine Journal
    Publisher
    SAGE Publications Ltd
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://www.doi.org/10.1177/2192568217703089
    Abstract
    Introduction: The objective of this guideline is to outline the role of magnetic resonance imaging (MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI. This review focused on longitudinal studies that controlled for baseline neurologic status. A multidisciplinary Guideline Development Group (GDG) used this information, their clinical expertise, and patient input to develop recommendations on the use of MRI for SCI patients. 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: Based on the limited available evidence and the clinical expertise of the GDG, our recommendations were: (1) “We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention, when feasible, to facilitate improved clinical decision-making” (quality of evidence, very low) and (2) “We suggest that MRI should be performed in adult patients in the acute period following SCI, before or after surgical intervention, to improve prediction of neurologic outcome” (quality of evidence, low). Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI. Copyright The Author(s) 2017.
    Sponsors
    The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by AOSpine, the Ontario Neurotrauma Foundation (ONF) and the AANS/CNS Section on Neurotrauma and Critical Care. Dr Fehlings wishes to acknowledge support from the Gerald and Tootsie Halbert Chair in Neural Repair and Regeneration and the DeZwirek Family Foundation. Dr Tetreault acknowledges support from a Krembil Postdoctoral Fellowship Award. Methodological support was provided by Spectrum Research, Inc.
    Keyword
    acute spinal cord injury
    clinical decision making
    clinical guideline
    guideline
    magnetic resonance imaging
    outcome prediction
    spinal cord injury
    traumatic spinal cord injury
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85029105002&doi=10.1177%2f2192568217703089&partnerID=40&md5=278e9a54f1796bb35af483367f5022e1; http://hdl.handle.net/10713/9907
    ae974a485f413a2113503eed53cd6c53
    10.1177/2192568217703089
    Scopus Count
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    UMB Open Access Articles 2017

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