Trends in the Use of Corticosteroids in the Management of Acute Spinal Cord Injury in North American Clinical Trials Network Sites
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Le résumé fourni par la source
Immunomodulatory therapeutics represent a potential neuroprotective strategy for the management of acute spinal cord injury (SCI). One of the most intensely debated neuroprotective drugs has been methylprednisolone sodium succinate (MPSS), which was investigated initially for its role in mitigating lipid peroxidation. More recently, the anti-inflammatory/immunomodulatory properties of MPSS have been increasingly appreciated. Over the past two decades, several systematic reviews and clinical practice guidelines related to MPSS use in SCI have been published. The goal of this study was to investigate the temporal changes in the use of steroids at North American Clinical Trials Network (NACTN) centers and to correlate these changes with the evolution in published literature and guidelines. Data on patients enrolled from 2008–2018 in the prospective, multi-center NACTN registry, and in whom information related to the use of steroids was available, were analyzed. Patients were stratified based on whether they received steroids or not. The primary outcome was the change in the rate of steroid use per year between 2008 and 2018. Secondary outcomes included cardiac, gastrointestinal and genitourinary (GIGU), pulmonary, and dermatological complications. We identified 608 patients, of whom 171 (28.1%) were given steroids. In 2008 and 2009, the prevailing paradigm across NACTN centers was in favor of steroid administration and as such 70% ( n = 56) of patients received steroids in 2008 and 71.9% ( n = 46) in 2009. An abrupt practice reversal was observed in 2010, whereby only 19.7% of patients ( n = 14) received steroids, a trend that continued over subsequent years. Increasing literature in the 2000s arguing against the use of steroids culminated in the 2013 CNS/AANS practice guidelines for the management of acute SCI. These guidelines recommended against the use of MPSS for the treatment of those with acute SCI. Over the following years (2013–2018), steroids continued to be an uncommonly used therapeutic option in NACTN centers (range 3.9–16.9%). Patients receiving steroids had significantly higher rates of pulmonary complications (87%, n = 147) compared with those not receiving steroids (73%, n = 265; p = 0.0003). Compared with patients receiving steroids, however, those who did not receive steroids had significantly higher rates of cardiac (40%, [ n = 146] versus 23%, [ n = 39]; p = 0.0001) and gastrointestinal/genitourinary complications (55%, [n = 189], versus 31%, [n = 52]; p < 0.0001). The 2013 AANS/CNS guidelines and preceding literature appeared to have an impact on dramatically lowering the rates of corticosteroid use for acute SCI in NACTN sites after 2009. Of note, this analysis may not reflect the impact of the 2017 AO Spine Clinical Practice guidelines, which suggested the use of methylprednisolone as a valid practice option for acute SCI, especially for cervical injuries. Enhanced patient involvement in the clinical decision-making process and opportunities to personalize SCI management exist in reference to the use of MPSS in acute SCI.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Trends in the Use of Corticosteroids in the Management of Acute Spinal Cord Injury in North American Clinical Trials Network Sites
- Date Crossref
- 23/08/2023
- Éditeur
- SAGE Publications
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University Health Network Krembil Brain Institute pays non établi dans la noticeÉtablissement de santé
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University of Toronto Department of Surgery pays non établi dans la noticeUniversité ou école supérieure
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University of Maryland pays non établi dans la noticeUniversité ou école supérieure
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Walter Reed National Military Medical Center Division of Neurosurgery pays non établi dans la noticeÉtablissement de santé
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Medical College of Wisconsin pays non établi dans la noticeUniversité ou école supérieure
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Duke University Department of Neurosurgery pays non établi dans la noticeUniversité ou école supérieure
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Duke University Hospital pays non établi dans la noticeÉtablissement de santé
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University of Miami The Miami Project to Cure Paralysis pays non établi dans la noticeUniversité ou école supérieure
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Methodist Hospital Department of Neurosurgery pays non établi dans la noticeÉtablissement de santé
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Thomas Jefferson University Department of Neurological and Orthopedic Surgery pays non établi dans la noticeUniversité ou école supérieure
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Kentucky Spinal Cord Injury Research Center pays non établi dans la noticeStructure de recherche
Krembil Brain Institute — University Health Network, Department of Surgery — University of Toronto et University of Maryland, avec 8 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.