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Corticosteroids in acute spinal cord injury
  1. Paul Wallman,
  2. Kevin Mackway-Jones
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL

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    Report by Paul Wallman, Clinical Fellow Search checked by Kevin Mackway-Jones, Consultant

    Clinical scenario

    A 40 year old man is involved in a road traffic accident. He has bony disruption at C7/T1 with acute spinal cord injury. He has no associated head injury and no other life threatening injuries. You wonder whether he should be given high dose corticosteroids for his cord injury.

    Three part question

    In [patients with acute traumatic spinal cord injury] do [high dose corticosteroids] improve [neurological outcome]?

    Search strategy

    Medline 1966–01/00 using the OVID interface. [({exp spinal injuries OR spinal injury.mp OR spinal injuries.mp} AND {exp acute disease OR acute.mp}) OR acute spinal injury.mp OR acute spinal injuries.mp] AND maximally sensitive RCT filter LIMIT to human AND english.

    Search outcome

    Altogether 245 papers were found of which 241 were irrelevant or of insufficient quality. The remaining four papers are shown in table 4.

    Table 4

    Comments

    No study has shown a benefit of corticosteroids in unselected patients. Stratification of data in NASCIS 2 has shown a subgroup of patients in whom high dose methylprednisolone appears to be of benefit but the method of analysis has been criticised.

    Clinical bottom line

    Patients presenting within eight hours of an acute spinal cord injury should be given methylprednisolone 30 mg/kg as soon as possible. Further corticosteroid treatment should be discussed with the admitting spinal unit.

    Report by Paul Wallman, Clinical Fellow Search checked by Kevin Mackway-Jones, Consultant

    References

    View Abstract

    Footnotes

    • The BMA library supplied the papers.

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