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Role of Steroids in Spinal Cord Inj

Bjorn, Pret pbjorn at emh.org
Fri Nov 5 12:38:17 GMT 2010


Exactly correct -- and a point we covered in some detail on the List
years ago.  Garbage in, garbage out.

My sense is that the more recent evidence finds little or no efficacy
accompanied by various degrees of risk to the patient's morbidity and
mortality.

It may take a few more civil suits to re-establish contemporary
practice; but the alternative is to do the wrong thing for the wrong
reasons.

Stop giving high-dose methylprednisolone for SCI.  And if you get sued,
let the List know.  I'm sure Dr. Mattox and several dozen of his
colleagues would eagerly and exhaustively review the evidence for your
jury.

Pret Bjorn, RN
Bangor, ME USA



-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Karim Brohi
Sent: Thursday, November 04, 2010 1:44 AM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Role of Steroids in Spinal Cord Inj

Be careful!  The "Cochrane Review" was written by the same person who
was lead on the NASCIS trials.  I would not call this a balanced
independent review.
Karim

On Wed, Nov 3, 2010 at 21:45, giuseppe nattino <natti56 at gmail.com>
wrote:
> hi all
>
> the last cochrane metanal. conclusions on this topic are: "High-dose
> methylprednisolone steroid therapy is the only pharmacologic therapy
shown
> to have efficacy in a phase three randomized trial when administered
within
> eight hours of injury. One trial indicates additional benefit by
extending
> the maintenance dose from 24 to 48 hours, if start of treatment must
be
> delayed to between three and eight hours after injury. There is an
urgent
> need for more randomized trials of pharmacologic therapy for acute
spinal
> cord injury."
> Last assessed as up-to-date: September 20. 2007
> http://www2.cochrane.org/reviews/en/ab001046.html
>
> this is obviously not conclusive, but the works showing no benefit (or
even
> harm) from the steroid use have got enough statistical strength to
dissuade
> everyone from using the steroid protocol?
>
> giuseppe
>
> giuseppe nattino
> I servizio anestesia e rianimazione
> ospedale a. manzoni
> lecco - italy
> --
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