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Acute Spinal Cord Trauma

Acute Spinal Cord Trauma. Robert L Wears, MD, MS Practice Guidelines: A Pan-American Symposium Santiago de Chile 7 October 2003. Critical Question. 20 yr old male fell 5 meters C4-5 fracture – dislocation Motor deficit Should he be given steroids? What is the evidence for benefit?

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Acute Spinal Cord Trauma

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  1. Acute Spinal Cord Trauma Robert L Wears, MD, MS Practice Guidelines: A Pan-American Symposium Santiago de Chile 7 October 2003

  2. Critical Question • 20 yr old male fell 5 meters • C4-5 fracture – dislocation • Motor deficit • Should he be given steroids? • What is the evidence for benefit? • What is the evidence for harm?

  3. Epidemiology • ~ 40 per million population annually • Typically • Young (20 – 35) • Male • Major disability • Shortened life expectancy • Major cost

  4. Study Selection • Randomized or quasi-randomized trials • Patients admitted for acute spinal cord injury • Exclude nerve root only, cauda equina syndrome • Outcome measures • Recovery of motor function (6 weeks, 6 months, 1 yr) (0 – 70 scale | 14 muscles 0-5) • Mortality

  5. Studies Included

  6. Studies Excluded

  7. Efficacy (Overall)

  8. Efficacy (< 8 hrs) *pooled at either 6 mo or 1 yr

  9. 24 Vs 48 Hours Treatment Mean (SD)

  10. Safety • Mortality, wound infection, GI bleed • No significant difference • Wide CI • Mortality RR .24 to 1.25 • Acute trauma studies low powered • Sauerland 2000 systematic review • 51 trials (including back surgery), > 2000 pts • No significant difference mortality, GI bleed, infection

  11. Conclusion • Benefit is modest at best • 5 – 8 points on 70 point scale • Class B • Minimum clinically important benefit undefined • Must be given early to be effective • No convincing evidence of harm • Low power limits safety assessment

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