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2017 ; 7
(3 Suppl
): 203S-211S
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English Wikipedia
A Clinical Practice Guideline for the Management of Patients With Acute Spinal
Cord Injury: Recommendations on the Use of Methylprednisolone Sodium Succinate
#MMPMID29164025
Fehlings MG
; Wilson JR
; Tetreault LA
; Aarabi B
; Anderson P
; Arnold PM
; Brodke DS
; Burns AS
; Chiba K
; Dettori JR
; Furlan JC
; Hawryluk G
; Holly LT
; Howley S
; Jeji T
; Kalsi-Ryan S
; Kotter M
; Kurpad S
; Kwon BK
; Marino RJ
; Martin AR
; Massicotte E
; Merli G
; Middleton JW
; Nakashima H
; Nagoshi N
; Palmieri K
; Skelly AC
; Singh A
; Tsai EC
; Vaccaro A
; Yee A
; Harrop JS
Global Spine J
2017[Sep]; 7
(3 Suppl
): 203S-211S
PMID29164025
show ga
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.