Utilization and effectiveness of methylprednisolone in a population-based sample of spinal cord injured persons

Short Title:
Utilization and effectiveness of methylprednisolone in a population-based sample of spinal cord injured persons
Model System:
Reference Type:
Journal Article
Accession No.:
Year, Volume, Issue, Page(s):
1995, vol. 33, issue 6, pp
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The second National Acute Spinal Cord Injury Study (NASCIS II) documented the efficacy of methylprednisolone in improving neurological outcomes following acute spinal cord injury (SCI). This study examined Colorado's population-based sample of SCI survivors to measure compliance with NASCIS II protocol guidelines, the effect of entry-point into the health care system, and to compare the neurological outcomes of recipients and nonrecipients of methylprednisolone. Medical records for two time periods, May 1990 through December 1991 (218 SCI patients) and January through December (145 SCI patients) were reviewed. The Frankel grading method was used to assess the extent of spinal cord injury and recovery. During the 1990 to 1991 and the 1993 periods, 46% and 61% of SCI survivors received the NASCIS II protocol, respectively. Records show that of 24 hospitals, none used the protocol on every SCI patient and some never used it. Small emergency facilities administered the protocol more often than large hospitals. Patients with cervical and thoracic injuries and severe neurological damage were more likely to receive the protocol. At time of discharge in the 1990 to 1991 period, 47% of recipients and 33% of nonrecipients improved at least one Frankel grade. In 1993, 43% of recipients and 21% of nonrecipients improved one Frankel grade. Thus, the study found no statistically significant difference in short term neurological outcomes among patients who did or did not receive methylprednisolone. This may be due to the limitations of the Frankel grading system. The study also concluded that despite widespread publicity, physicians and hospitals did not rapidly or consistently implement the NASCIS II protocol.
Gerhart, K. A.; Johnson, R. L.; Menconi, J.; Hoffman, R. E.; Lammertse, D. P.
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