Recently had a debate on use of iv steroids after spinal cord fracture (c7) in the ED. MD says no due to new research, any thoughts?
Jul 23, '12
As far as I know the ACS guidelines have changed from "you HAVE to give steroids regardless of the side effects" to "you CAN give steroids if you prefer but it has many side effects".
The positive effects found in the NASCIS II and III studies regarding methylprednisolone after spinal cord injury were questioned due to some dodgy statistics. Furthermore some clinicians found it doubtful if the supposed improvements in motor function were significant enough to be of clinical value.
In my hospital we don't give steroids to all cases of spinal cord injury anymore. Usually in very early stages it is still administered (e.g. three hours post event) but little time after that we won't give them any steroids due to hyperglycemic problems and metabolic decompensation due to high dose steroids.
Jul 23, '12
We follow the same practices in Virginia. However we also use induced hyperthermia to decrease swelling, however not to the point as we would with a cardiac arrest patient from the field
Jul 23, '12
I love medscape.
......requires registration but is is free no strings.
Steroid Therapy in SCI and Controversies
"The National Acute Spinal Cord Injury Studies (NASCIS) II and III,a Cochrane Database of Systematic Reviews
article of all randomized clinical trials,and other published reports, have verified significant improvement in motor function and sensation in patients with complete or incomplete spinal cord injuries (SCIs) who were treated with high doses of methylprednisolone within 8 hours of injury. "
Medscape: Medscape Access
The most common levels of injury on admission are C4, C5 (the most common), and C6, whereas the level for paraplegia is the thoracolumbar junction (T12). The most common type of injury on admission is American Spinal Injury Association (ASIA) level A (see Neurologic level and extent of injury under Clinical).
As a result of the controversy over the NACSIS II and III studies, a number of professional organizations have revised their recommendations pertaining to steroid therapy in spinal cord injury.
The Congress of Neurological Surgeons (CNS) has stated that steroid therapy "should only be undertaken with the knowledge that the evidence suggesting harmful side effects is more consistent than any suggestion of clinical benefit."The American College of Surgeons (ACS) has modified their advanced trauma life support (ACLS) guidelines to state that methylprednisolone is "a recommended treatment" rather than "the recommended treatment." The Canadian Association of Emergency Physicians (CAEP) is no longer recommending high-dose methylprednisolone as the standard of care.
In a survey conducted by Eck and colleagues, 90.5% of spine surgeons surveyed used steroids in spinal cord injury, but only 24% believed that they were of any clinical benefit.Note that the investigators not only discovered that approximately 7% of spine surgeons do not recommend or use steroids at all in acute spinal cord injury, but that most centers were following the NASCIS II trial protocol.
Jul 24, '12
In my city in OZ, the major spinal referral centre flat out don't give steroids.
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