Abstract
Background Methylprednisolone is the only neuroprotective therapy advocated in acute non-penetrating spinal cord injury. Trials indicate improved neurological outcome following early administration of a high dose regime. The National Spinal Injuries Unit (NSIU) has promoted this regime by a simple laminated poster sent to all Irish A&E departments.
Aim To assess the use of methylprednisolone in patients with spinal cord injuries.
Method A retrospective audit of patient data for all patients admitted with traumatic neurological impairment over a 12-month period.
Results One hundred ninety-six patients were admitted during the study period, 28 (14%) received intravenous methylprednisolone of which six had clear records documenting compliance. One patient received both dexamethasone and methylprednisolone in high doses and three had incorrect bolus dosages administered. Six patients received methylprednisolone infusion longer than the protocol, while five patients were given infusions shorter than recommended. Three patients were admitted to the unit that could have received the steroid regime at the point of transfer.
Conclusions There was poor documentation of prescription orders and timing of administration. Only six patients had clear documentation allowing confirmation of adherence to the protocol of the National Acute Spinal Cord Injury Study (NASCIS) III trial.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bracken MB, Collins WF, Freeman DF. Efficacy of methylprednisolone in acute spinal cord injury.JAMA 1984; 251: 45–52.
Bracken MB, Shepard MJ, Collins WF et al. A randomised controlled trial of methylprednisolone or naloxone in the treatment of acute spinal cord injury.N Engl J Med 1990; 322: 1405–11.
Bracken MB, Shepard MJ, Holford TR 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: 1597–604.
Callanan I, Walsh M. Management of spinal injuries. Poster. 1998.Available form the National Spinal Injuries Unit, Mater Misericordiae Hospital, Dublin.
Coleman WP, Benzel D, Cahill DW 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: 185–99.
Hurlbert RJ. Methylprednisolone for acute spinal cord injury: an inappropriate standard of care.J Neurosurg 2000; 93: 1–7.
Geisler FH, Coleman WP, Grieco G et al. The Sygen® multicentre acute spinal injury study.Spine 2001; 26 (suppl 1): S87–98.
Fehlings MG, Bracken MG. Summary statement: The Sygen® (GM-1 Ganglioside) clinical trial in acute spinal cord injury.Spine 2001; 26 (suppl 1): S99–100.
Matsumoto T, Tamaki T, Kawakami M, Yoshida M, Ando M, Yamada H. Early complications of high dose methylprednisolone sodium succinate treatment in the follow up of acute cervical spinal cord injury.Spine 2001; 26: 426–30.
Bracken MB, Shepard MJ, Hellenbrand KG et al. Methylprednisolone and neurological function one year after spinal cord injury.J Neurosurg 1985; 63: 704–13.
Goldfien A. Adrenocorticosteroids and adrenocortical antagonists. In: Basic and clinical pharmacology (3rd Edition). Ed Katzung BG. Appleton and Lange, CA 1987: 453.
Fehlings MG. Editorial: Recommendations regarding the use of methylprednisolone in acute spinal cord injury.Spine 2001; 26 (suppl 1): S56–57.
Delamarter RB, Coyle J. Acute management of spinal cord injuries.J Am Acad Ortho Surg 1999; 7: 166–75.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
O’Connor, P., McCormack, O., Gavin, C. et al. Methylprednisolone in acute spinal cord injuries. Ir J Med Sci 172, 24–26 (2003). https://doi.org/10.1007/BF02914781
Issue Date:
DOI: https://doi.org/10.1007/BF02914781