Introduction: The objective of this study is to develop guidelines that outline the appropriate use of MPSS in patients with traumatic spinal cord injury (SCI).
Methods: A systematic review of the literature was conducted to address the following key questions: (1) what is the efficacy, effectiveness and safety of MPSS compared with no pharmacologic treatment?; and (2) what is the evidence that MPSS has differential efficacy or safety in subpopulations? A multidisciplinary guideline development group used this information, in combination with their clinical expertise, to develop recommendations for the use of MPSS. The benefits and harms, financial impact, acceptability, feasibility and patient preferences of each recommendation were carefully considered.
Results: The main conclusions from the systematic review included: (1) there were no differences in motor change at any time point in patients treated with MPSS compared to those not receiving steroids; (2) when MPSS was administered within 8 hours of injury, pooled results at 6- and 12-months indicate modest improvements in mean motor scores in the MPSS group compared with the control group; (3) there was no statistical difference between treatment groups in the risk of death, wound infection, GI hemorrhage, sepsis, urinary tract infection pneumonia or decubiti. Our recommendations were: (1) “We suggest not offering a 24-hour infusion of high dose MPSS to adult patients who present after 8 hours of acute SCI”; (2) “When started within 8 hours of injury, we suggest that a 24 hour infusion of high dose MPSS be offered to adult patients with acute SCI as a treatment option”; and (3) “We suggest not offering a 48-hour infusion of high dose MPSS for adult patients with acute SCI.”
Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in patients with SCI by encouraging clinicians to make evidence-informed decisions.
Patient Care: This research aims to settle existing controversy surrounding the use of MPSS in patients with SCI. Our results suggest potential benefit when administered within 8 hours of injury.
Learning Objectives: To provide guidance on the use of MPSS in patients with SCI.