Methylprednisolone for acute spinal cord injury: 5-year practice reversal.
OBJECTIVE
To re-evaluate practice patterns for methylprednisolone (MP) administration in patients with acute spinal cord injury (SCI) within the spinal surgery community across Canada five years after the publication of practice recommendations.


METHODS
Canadian orthopedic and neurological spine surgeons were surveyed at their respective annual meetings about their practice of steroid administration for acute SCI by means of a questionnaire comprised of the same seven questions posed five years ago plus an additional question related to change of view.


RESULTS
Forty-two surgeons and twenty-one residents directly involved in the acute management of SCI completed the questionnaire. Seventy-six percent of spinal surgeons do not prescribe MP for SCI in sharp contrast to 76% who prescribed it five years ago. Of the 24% who use steroids, the NASCIS II dosing regimen is most commonly followed. One third of physicians continue to administer MP because of fear of litigation.


CONCLUSIONS
Over a five year period there has been a complete reversal in practice patterns of MP administration for SCI, along with an increased familiarity of the published literature. Attendance at meetings, participation in local group discussions, and peer-reviewed publications appear effective in altering practice preferences arising from peer pressure and even fear of litigation.
Hurlbert
R John
RJ
University of Calgary Spine Program and Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada.
Hamilton
Mark G
MG
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002170:Canada; D004363:Drug Utilization; D019538:Health Care Surveys; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use*; D009493:Neurosurgery / Q000639:trends; D009985:Orthopedics / Q000639:trends; D013119:Spinal Cord Injuries / Q000188:drug therapy*; D011795:Surveys and Questionnaires
D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone