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

Published online by Cambridge University Press:  02 December 2014

R. John Hurlbert  and
Mark G. Hamilton
R. John Hurlbert
Affiliation:
The University of Calgary Spine Program and Division of Neurosurgery, University of Calgary, Calgary, Alberta
Mark G. Hamilton
Affiliation:
The University of Calgary Spine Program and Division of Neurosurgery, University of Calgary, Calgary, Alberta
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Abstract

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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:

RÉSUMÉ:<span class='italic'><span class='bold'>Objectif</span></span>:

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 stéroïs 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 phase aiguë ont complété le questionnaire. Soixante-seize pour cent des chirurgiens ne prescrivent pas de MP pour une LTMÉ, contrairement à ce que faisaient 76% d'entre eux il y a cinq ans. Les 24% qui prescrivent des stéroïs se conforment généralement au mode d'administration de NASCIS II. Un tiers des médecins continue à administrer la MP par crainte d'une poursuite judiciaire.

Conclusions:

Au cours des cinq dernières années, il y a eu un renversement complet des habitudes de pratique en ce qui concerne l'administration de la MP chez les patients qui ont subi une LTMÉ, de même qu'une plus grande familiarisation avec la littérature à ce sujet. La participation à des congrès et à des groupes locaux de discussion et les publications révisées par des pairs semblent efficaces pour modifier les préférences de pratique basées sur la pression des pairs et même sur la crainte de poursuites judiciaires.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 1 , March 2008 , pp. 41 - 45
Copyright
Copyright © The Canadian Journal of Neurological 2008

References

1. Bracken, MB, Shepard, MJ, Collins, WF, Holford, TR, Young, W, Baskin, D, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury: results of the second national acute spinal cord injury study. N Engl J Med. 1990; 322: 1405–11.Google Scholar
2. Bracken, MB, Shepard, MJ, Collins, WF, Holford, TR, Baskin, D, Eisenberg, HM, et al. Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. J Neurosurg. 1992; 76: 23–31.CrossRefGoogle ScholarPubMed
3. Bracken, MB, Shepard, MJ, Holford, TR, Seo-Summers, L, Aldrich, EF, Fazl, M, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. JAMA. 1997; 277: 1597–1604.CrossRefGoogle ScholarPubMed
4. Bracken, MB, Shepard, MJ, Holford, TR, Leo-Summers, L, Aldrich, EF, Fazl, M, et al. Methylprednisolone or tirilazad mesylate administration after acute spinal cord injury: 1-year follow-up. J Neurosurg. 1998; 89: 699–706.Google Scholar
5. Nesathurai, S. Steroids and spinal cord injury: revisiting the NASCIS 2 and NASCIS 3 trials. J Trauma. 1998; 45: 1088–93.Google Scholar
6. Coleman, WP, Benzel, E, Cahill, DW, Ducker, T, Geisler, F, Green, B, et al. A critical appraisal of the reporting of the National Acute Spinal Cord Injury Studies (II and III) of methylprednisolone in acute spinal cord injury. J Spinal Disord. 2000; 13(3):185–99.Google Scholar
7. Hurlbert, RJ. Methylprednisolone for acute spinal cord injury: an inappropriate standard of care. J Neurosurg. 2000; 93: 1–7.Google Scholar
8. Short, DJ, El Masry, WS, Jones, PW. High dose methylprednisolone in the management of acute spinal cord injury: a systematic review from a clinical perspective. Spinal Cord. 2000; 38: 273–86.Google Scholar
9. Hurlbert, RJ. The role of steroids in acute spinal cord injury: an evidence-based analysis. Spine. 2001; 26(24S):S39–46.Google Scholar
10. Hurlbert, RJ, Moulton, R. Why do you prescribe methylprednisolone for acute spinal cord injury? Can J Neurol Sci. 2002; 29: 236–9.CrossRefGoogle Scholar
11. Hugenholtz, H, Cass, DE, Dvorak, MF, Fewer, DH, Fox, RJ, Izukawa, DM, et al. High-dose methylprednisolone for acute closed spinal cord injury: only a treatment option. Can J Neurol Sci. 2002; 29: 227–35.CrossRefGoogle ScholarPubMed
12. Hadley, MN, Walters, BC, Grabb, PA, Oyesiku, NM, Przybylski, GJ, Resnick, DK, et al. Pharmacological therapy after acute spinal cord injury. Neurosurgery. 2002; 50Suppl: 63–72.Google Scholar
13. Bledsoe, BE, Wesley, AK, Salomone, P. High-dose steroids for acute spinal cord injury in emergency medical services. Prehosp Emerg Care. 2004; 8(3):313–16.Google Scholar
14. Pollard, DE, Apple, DF. Factors associated with improved neurological outcomes in patients with incomplete tetraplegia [clinical case series]. Spine. 2003; 28(1):33–8.Google Scholar
15. Qian, T, Guo, X, Levi, AD, Vanni, S, Shebert, RT, Sipski, ML. High-dose methylprednisolone may cause myopathy in acute spinal cord injury patients. Spinal Cord. 2005; 43: 199–203.Google Scholar
16. Aito, S, D’Andrea, M, Werhagen, L. Spinal cord injuries due to diving accidents. Spinal Cord. 2005; 43(2):109–16.CrossRefGoogle ScholarPubMed
17. Hurlbert, RJ. Strategies of medical intervention in the management of acute spinal cord injury. Spine. 2006; 31(11):516–21.Google Scholar
18. Sayer, FT, Kronvall, E, Nilsson, OG. Methylprednisolone treatment in acute spinal cord injury: the myth challenged through a structured review of the literature. Spine. 2006; 6: 335–43.Google Scholar
19. Leypold, BG, Flanders, AE, Schwartz, ED, Burns, AS. The impact of methylprednisolone on lesion severity following spinal cord injury. Spine. 2007; 32(3):373–78.Google Scholar
20. Bracken, MB. Pharmacological interventions for acute spinal cord injury. Cochrane Database of Systematic Reviews (2): CD001046, 2000.Google Scholar
21. Bracken, MB. Steroids for acute spinal cord injury (update). Cochrane Database of Systematic Reviews (3):CD001046, 2002.Google Scholar
22. Bracken, MB. Steroids for acute spinal cord injury (update). Cochrane Database of Systematic Reviews (2):CD001046, 2007.Google Scholar