Failure to administer methylprednisolone for acute traumatic spinal cord injury—a prospective audit of 100 patients from a regional spinal injuries unit

Abstract

Overview: The National Acute Spinal Cord Injury Studies (NASCIS II and III) and the Cochrane review advocate the administration of high dose methylprednisolone following acute traumatic spinal cord injury. Objective: To determine the actual use and correct implementation of the NASCIS protocols in patients referred to a regional spinal injuries unit. Design: Observational study on the timing and correct dosage of methylprednisolone. The admission Frankel grade, American Spinal Injury Association (ASIA) neurological classification were recorded prospectively. Subjects: The 100 consecutive patients with complete or incomplete spinal cord injuries (Frankel grade A–D) were studied over a 2 years period. Main outcome measure: Correct administration of methylprednisolone according to the NASCIS protocols. Results: During the study period only 25% of the patients admitted to our spinal injuries unit received methylprednisolone at the referring hospital according to the NASCIS protocols. An additional 10 patients were given methylprednisolone incorrectly. Conclusion: Evidence based medicine is not being practiced in the management of patients with acute spinal cord injury.