Changes in the use of the methylprednisolone protocol for traumatic spinal cord injury in Switzerland.
METHODS
A retrospective cohort study.


OBJECTIVE
To examine the differences in the use of the methylprednisolone protocol for traumatic spinal cord injury before and after the publication of new guidelines in Switzerland.


BACKGROUND
The use of the methylprednisolone protocol for traumatic spinal cord injury changed after the publication of new guidelines. The rate of physicians prescribing high-dose methylprednisolone for patients with acute spinal cord injury was studied. Two intervals, each comprising 24 months before and after the publication of the consensus article in Switzerland, were compared. As a secondary parameter, the neurological development during the rehabilitation period was compared.


METHODS
The charts of all adult patients who were referred for treatment of a spine or spinal cord injury during the periods from April 2001 to March 2003 and from April 2008 to March 2010 were retrospectively reviewed for demographic and medical details, the application of methylprednisolone within the first 48 hours after the injury, the diagnoses at the time of their referral, and the diagnosis at the time of hospital discharge. Classification of traumatic spinal cord injury was made according to the guidelines of the American Spinal Injury Association. Neurological improvement concerning the level of injury was defined as a change of this segment to a more caudal one or a complete normalization of sensory and motor function.


RESULTS
During the 2 study periods, 110 patients (2001-2003) and 116 patients (2008-2010) were included. Between 2001 and 2003, 96% of patients with a neurological deficit after spinal cord injury were treated with high-dose methylprednisolone, whereas this rate dropped to 23% during the second time interval. In both treatment periods, neurological improvement during the rehabilitation period (mean: 6 mo) did not differ significantly. Pooled data of all patients with a neurological deficit in both study periods (n = 159) showed improved neurological levels in 32% of patients treated with methylprednisolone and 28% of patients without this therapy, without a statistical difference between the groups.


CONCLUSIONS
In Switzerland, the acceptance of the guidelines for treating traumatic spinal cord injury with high-dose methylprednisolone has been extremely high in the past. The use of high-dose methylprednisolone has decreased to a much lower level in Switzerland after the publication of new guidelines, which is comparable to various other countries. Despite these changes, no differences in the neurological outcome were detected between the observed patient populations.
Department of Intensive Care Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland. peter.felleiter@paranet.ch
Peter
P
Felleiter
Nicole
N
Müller
Frederik
F
Schumann
Olga
O
Felix
Peter
P
Lierz
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004305:Dose-Response Relationship, Drug; D004363:Drug Utilization / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000627:therapeutic use; D017410:Practice Guidelines as Topic / Q000592:standards*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000188:drug therapy* / Q000473:pathology; D013557:Switzerland; D055815:Young Adult
D018696:Neuroprotective Agents; D008775:Methylprednisolone