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    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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    Author
    Fehlings, M.G.
    Wilson, J.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/10.1177/2192568217703085
    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. Copyright The Author(s) 2017.
    Sponsors
    This research was supported by AOSpine, the Ontario Neurotrauma Foundation (ONF) and the AANS/CNS Section on Neurotrauma and Critical Care.
    Keyword
    acute spinal cord injury
    guideline
    methylprednisolone sodium succinate
    MPSS
    spinal cord injury
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85029030268&doi=10.1177%2f2192568217703085&partnerID=40&md5=2977f5c0004fdd7c30611db7c310c8d9; http://hdl.handle.net/10713/9909
    ae974a485f413a2113503eed53cd6c53
    10.1177/2192568217703085
    Scopus Count
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    UMB Open Access Articles 2017

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