A systematic review of the management of autonomic dysreflexia after spinal cord injury.
OBJECTIVE
To review systematically the clinical evidence on strategies to prevent and manage autonomic dysreflexia (AD).


METHODS
A key word search of several databases (Medline, CINAHL, EMBASE, and PsycINFO), in addition to manual searches of retrieved articles, was undertaken to identify all English-language literature evaluating the efficacy of interventions for AD.


METHODS
Studies selected for review included randomized controlled trials (RCTs), prospective cohort studies, and cross-sectional studies. Treatments reviewed included pharmacologic and nonpharmacologic interventions for the management of AD in subjects with spinal cord injury. Studies that failed to assess AD outcomes (eg, blood pressure) or symptoms (eg, headaches, sweating) were excluded.


METHODS
Studies were critically reviewed and assessed for their methodologic quality by 2 independent reviewers.


RESULTS
Thirty-one studies were assessed, including 6 RCTs. Preventative strategies to reduce the episodes of AD caused by common triggers (eg, urogenital system, surgery) primarily were supported by level 4 (pre-post studies) and level 5 (observational studies) evidence. The initial acute nonpharmacologic management of an episode of AD (ie, positioning the patient upright, loosening tight clothing, eliminating any precipitating stimulus) is supported by clinical consensus and physiologic data (level 5 evidence). The use of antihypertensive drugs in the presence of sustained elevated blood pressure is supported by level 1 (prazosin) and level 2 evidence (nifedipine and prostaglandin E(2)).


CONCLUSIONS
A variety of options are available to prevent AD (eg, surgical, pharmacologic) and manage the acute episode (elimination of triggers, pharmacologic); however, these options are predominantly supported by evidence from noncontrolled trials, and more rigorous trials are required.
International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada.
Andrei
A
Krassioukov
Darren E
DE
Warburton
Robert
R
Teasell
Janice J
JJ
Eng
D020211:Autonomic Dysreflexia / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D013119:Spinal Cord Injuries / Q000150:complications*