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Tue Feb 13 09:30:03 GMT 2007

Just when we thought we had a UK consensus, this was published in EMJ last year (23:550-553). Forgive me if you have already noted this. 

High dose methylprednisolone in the immediate management of acute, blunt spinal cord injury: what is the
current practice in emergency departments, spinal units, and neurosurgical units in the UK?
A E Frampton, C A Eynon

Background: The National Acute Spinal Cord Injuries Studies and the Cochrane Review advocate the
administration of high dose methylprednisolone following acute traumatic spinal cord injury. However,
controversy surrounds its use and approaches between different units are often inconsistent.
Methods: A questionnaire was sent to all emergency departments receiving major trauma and all
specialist neurosurgical and spinal units in the UK to determine the current practice regarding the use of
high dose methylprednisolone in the immediate management of acute, blunt spinal cord injuries.
Results: Of 250 emergency departments, 187 replied to the questionnaire. Twelve of the 26 departments
with a neurosurgical or spinal service on site stated they received consistent advice from specialist teams.
Sixty four departments had a written policy regarding the treatment of spinal injuries, which in 51
departments contained advice about the administration of methylprednisolone. Of the 128 departments
who gave methylprednisolone, 88 did so only on the advice of a specialist team, with the remaining 40
giving steroids immediately on identification of the injury. Ten out of 11 spinal units replied, of whom only
two advised the used of steroids. Of the 34 neurosurgical units approached, seven out of 17 responders
had a policy recommending the use of steroids. Of the 10 units who did not consistently recommend the
use of steroids, seven had practise that varied between consultants.
Conclusion: Currently practice varies in the UK regarding the immediate use of methylprednisolone after
spinal injury. Clear guidelines need to be established to achieve a more consistent approach.

Paul Harrison
Clinical Development Officer
princess Royal Spinal Injuries Centre
Sheffield UK

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Errington Thompson
Sent: 12 February 2007 23:20
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Steroids in SCI (was RE: (no subject))

{{{}}}

Errington C. Thompson, MD, FACS, FCCM
Trauma/Surgical Critical Care
Mission Hospital
Asheville, NC
Author - A Letter to America
www.whereistheoutrage.net

Everyone deserves to make an informed decision
                                - Errington Thompson, MD

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Karim Brohi
Sent: Monday, February 12, 2007 4:21 PM
To: Trauma &amp, Critical Care mailing list
Subject: Re: Steroids in SCI (was RE: (no subject))

Oh for pity's sake will you all just get a grip.
If you want to talk about politics on this list then the appropriate steps
are:

1. Change the subject of the email from 'Steroids in SCI' to 'Return of the perpetual circular argument by the same perpetual offenders with nothing new to add.'

2. Change the 'From:' field from your name to 'I may as well be a spammer the way I fill your email with my hyperbole'

3. Change the 'To:' field from 'trauma-list at trauma.org' to '
anywhere-else-but at here.com'

meanwhile, in relation to the subject of this email, you can review the data (or lack of it) on steroids in SCI at:
http://www.trauma.org/index.php?/main/article/394/

Karim

On 12/02/07, Charles Brault <c_brault at yahoo.com> wrote:
>
> BIAS ?
>
> How about FACT ! ?
>
> BIAS would be if you still think their is an actual link between El 
> Qaida and Irak ... other than Saddam was the US's best bet in 
> controling terrorism in his part of the world
>
> Are do you still think going into Irak was a better soltuion to reduce 
> terrorism ? ? ?
>
> otherwise
>
> I agree
>
> It's unCute (coot?) for Bret to slip a political fast one !
>
> ... like nobody is going to notice))))
>
>
> Totally uncauled for
>
> Charles
>
>
> ----- Original Message ----
> From: "Bjorn, Pret" <pbjorn at emh.org>
> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
> Sent: Monday, February 12, 2007 3:22:18 PM
> Subject: RE: Steroids in SCI (was RE: (no subject))
>
>
> Political bias?  Moi?
>
> I was merely invoking an analogous model.
>
> You're so cynical.
>
> Pret
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald Gross
> Sent: Monday, February 12, 2007 12:50 PM
> To: Trauma & Critical Care mailing list
> Subject: Steroids in SCI (was RE: (no subject))
>
> >PASG's.  The Trendelenburg position.  Atropine and asystole.
> Hyperventilation and brain injury.  Iraq and 9/11.
>
> Pret,
> That was beautiful!!   I like the way you weave your political bias into
> the medical thread!  That's why I love ya, brother!!  ;-)
>
> Take care,
> Ron
>
>
>
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