Failure to administer methylprednisolone for acute traumatic spinal cord injury-a prospective audit of 100 patients from a regional spinal injuries unit.
BACKGROUND
The National Acute Spinal Cord Injury Studies (NASCIS II and III) and the Cochrane review advocate the administration of high dose methylprednisolone following acute traumatic spinal cord injury.


OBJECTIVE
To determine the actual use and correct implementation of the NASCIS protocols in patients referred to a regional spinal injuries unit.


METHODS
Observational study on the timing and correct dosage of methylprednisolone. The admission Frankel grade, American Spinal Injury Association (ASIA) neurological classification were recorded prospectively.


METHODS
The 100 consecutive patients with complete or incomplete spinal cord injuries (Frankel grade A-D) were studied over a 2 years period.


METHODS
Correct administration of methylprednisolone according to the NASCIS protocols.


RESULTS
During the study period only 25% of the patients admitted to our spinal injuries unit received methylprednisolone at the referring hospital according to the NASCIS protocols. An additional 10 patients were given methylprednisolone incorrectly.


CONCLUSIONS
Evidence based medicine is not being practiced in the management of patients with acute spinal cord injury.
Specialist Registrar, Trauma and Orthopaedics, South West Thames, UK. sean.molloy@btinternet.com
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Casey
D000208:Acute Disease; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D002574:Cervical Vertebrae / Q000293:injuries; D002985:Clinical Protocols; D016001:Confidence Intervals; D004334:Drug Administration Schedule; D004739:England; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008159:Lumbar Vertebrae; D008297:Male; D008485:Medical Audit; D008775:Methylprednisolone / Q000008:administration & dosage*; D018696:Neuroprotective Agents / Q000008:administration & dosage*; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents; D018696:Neuroprotective Agents; D008775:Methylprednisolone