Department of Intensive Care Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland.
Spine (Phila Pa 1976). 2012 May 15;37(11):953-6. doi: 10.1097/BRS.0b013e31823a07a2.
A retrospective cohort study.
To examine the differences in the use of the methylprednisolone protocol for traumatic spinal cord injury before and after the publication of new guidelines in Switzerland.
The use of the methylprednisolone protocol for traumatic spinal cord injury changed after the publication of new guidelines. The rate of physicians prescribing high-dose methylprednisolone for patients with acute spinal cord injury was studied. Two intervals, each comprising 24 months before and after the publication of the consensus article in Switzerland, were compared. As a secondary parameter, the neurological development during the rehabilitation period was compared.
The charts of all adult patients who were referred for treatment of a spine or spinal cord injury during the periods from April 2001 to March 2003 and from April 2008 to March 2010 were retrospectively reviewed for demographic and medical details, the application of methylprednisolone within the first 48 hours after the injury, the diagnoses at the time of their referral, and the diagnosis at the time of hospital discharge. Classification of traumatic spinal cord injury was made according to the guidelines of the American Spinal Injury Association. Neurological improvement concerning the level of injury was defined as a change of this segment to a more caudal one or a complete normalization of sensory and motor function.
During the 2 study periods, 110 patients (2001-2003) and 116 patients (2008-2010) were included. Between 2001 and 2003, 96% of patients with a neurological deficit after spinal cord injury were treated with high-dose methylprednisolone, whereas this rate dropped to 23% during the second time interval. In both treatment periods, neurological improvement during the rehabilitation period (mean: 6 mo) did not differ significantly. Pooled data of all patients with a neurological deficit in both study periods (n = 159) showed improved neurological levels in 32% of patients treated with methylprednisolone and 28% of patients without this therapy, without a statistical difference between the groups.
In Switzerland, the acceptance of the guidelines for treating traumatic spinal cord injury with high-dose methylprednisolone has been extremely high in the past. The use of high-dose methylprednisolone has decreased to a much lower level in Switzerland after the publication of new guidelines, which is comparable to various other countries. Despite these changes, no differences in the neurological outcome were detected between the observed patient populations.
回顾性队列研究。
在瑞士新指南发布前后，观察外伤性脊髓损伤使用甲泼尼龙方案的差异。
外伤性脊髓损伤使用甲泼尼龙方案在新指南发布后发生了变化。研究了急性脊髓损伤患者使用高剂量甲泼尼龙的医生比例。比较了瑞士共识文章发表前后各 24 个月的两个时间段。作为次要参数，比较了康复期间的神经发育情况。
回顾性查阅了 2001 年 4 月至 2003 年 3 月和 2008 年 4 月至 2010 年 3 月期间因脊柱或脊髓损伤就诊的所有成年患者的图表，以获取人口统计学和医疗详细信息、损伤后 48 小时内应用甲泼尼龙的情况、转诊时的诊断以及出院时的诊断。外伤性脊髓损伤的分类根据美国脊髓损伤协会的指南进行。神经功能改善定义为损伤节段向更低位段或感觉和运动功能完全正常的改变。
在两个研究期间，纳入了 110 例患者（2001-2003 年）和 116 例患者（2008-2010 年）。2001 年至 2003 年间，96%的脊髓损伤后有神经功能缺损的患者接受了大剂量甲泼尼龙治疗，而在第二个时间段这一比例降至 23%。在两个治疗期间，康复期间（平均：6 个月）的神经功能改善没有显著差异。两个研究期间所有有神经功能缺损的患者（n=159）的汇总数据显示，接受甲泼尼龙治疗的患者中有 32%的神经水平改善，未接受该治疗的患者中有 28%的神经水平改善，两组间无统计学差异。
在瑞士，过去接受大剂量甲泼尼龙治疗外伤性脊髓损伤的指南的比例极高。在新指南发布后，瑞士大剂量甲泼尼龙的使用已大大降低，与其他许多国家相当。尽管发生了这些变化，但在观察的患者群体中，没有发现神经预后的差异。
