|NICE Guidelines on Corticosteroid Use in Acute Spinal Cord Injury||– Do not use methylprednisolone, nimodipine, or naloxone in the acute stage of traumatic spinal cord injury to provide neuroprotection and prevent secondary deterioration. – Reference: NICE guideline on spinal injury assessment and initial management (NICE 2016 Feb:NG41)|
|AANS/CNS Guidelines on Corticosteroid Use in Acute Spinal Cord Injury||– Do not give methylprednisolone for acute spinal cord injury; high-dose corticosteroids are associated with adverse effects and death (AANS/CNS Level I) – Reference: AANS/CNS recommendations for pharmacological therapy for acute SCI (Neurosurgery 2013 Mar;72 Suppl 2:93)|
|CSCM Guidelines on Corticosteroid Use in Acute Spinal Cord Injury||– No clinical evidence to definitively recommend the use of any neuroprotective medication, including steroids, to improve functional recovery (CSCM Expert consensus, Strong agreement). – Stop the use of methylprednisolone as soon as possible in neurologically normal patients, and in patients whose previous neurologic symptoms have resolved, to reduce side effects (CSCM Expert consensus, Strong agreement). – Reference: CSCM guideline on early acute management in adults with SCI (J Spinal Cord Med 2008;31(4):403)|
|SCI-GDG Guidelines on Corticosteroid Use in Acute Spinal Cord Injury||– Consider a 24-hour infusion of high-dose methylprednisolone sodium succinate for adults who present within 8 hours of injury (SCI-GDG Grade Weak, Level Moderate). – Do not offer a 48-hour infusion of high-dose methylprednisolone sodium succinate (SCI-GDG Grade Weak, No direct evidence).|
– Reference: Global Spine Journal 2017 Sep;7(3 Suppl):203
- Corticosteroids have been used to treat spinal cord injury since the 1960s.
- The National Acute Spinal Cord Injury Study (NASCIS) trials demonstrated some benefits of using corticosteroids, but the trials have faced criticisms about the use of subgroup analysis, potential confounders, clinical significance of results, reproducibility, and risk of complications.
- The use of corticosteroids for acute spinal cord injury remains controversial, with uneven adoption of the NASCIS recommendations among healthcare providers.
- Studies of practice patterns in North America and the United Kingdom suggest decreasing use of corticosteroids for acute spinal cord injury, but medicolegal concerns are often cited as the justification for use.
- Recent guidelines from the American Association of Neurological Surgeons/Congress of Neurological Surgeons and the European Association of Neurosurgical Societies recommend against using corticosteroids for acute spinal cord injury beyond 8 hours post-injury.
1.The use of corticosteroids for acute spinal cord injury is controversial and the guidelines recommend against their routine use beyond 8 hours after injury.
2.Clinical pharmacists can play a crucial role in monitoring patients who are receiving steroids for acute spinal cord injury to manage potential side effects such as increased risk of infections, gastrointestinal bleeding, and hyperglycemia.
3.Pharmacists should also educate healthcare providers and patients about the potential risks and benefits of steroid use, and the importance of following evidence-based guidelines to improve patient outcomes.
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• American Academy of Emergency Medicine. 1997-2003. Position Statements Steroids in Acute Spinal Care Injury. Available at: http://www.aaem.org/positionstatements/steroidsinacuteinjury.php.Accessed March 5, 2023.
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