Hejrati Nader, Moghaddamjou Ali, Pedro Karlo, Alvi Mohammed Ali, Harrop James S, Guest James D, Kwon Brian K, Fehlings Michael G
Division of Neurosurgery and Spine Program, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Global Spine J. 2024 Mar;14(2):546-560. doi: 10.1177/21925682221116888. Epub 2022 Aug 29.
Cross-sectional, international survey.
To examine current international practices as well as knowledge, adoption, and barriers to guideline implementation for acute spinal cord injury (SCI) management.
A survey was distributed to members of AO Spine. The questionnaire was structured to obtain demographic data and preferred acute SCI practices surrounding steroid use, hemodynamic management, and timing of surgical decompression.
593 members completed the survey including orthopaedic surgeons (54.3%), neurosurgeons (35.6%), and traumatologists (8.4%). Most (61.2%) respondents were from low and middle-income countries (LMICs). 53.6% of physicians used steroids for the treatment of acute SCIs. Respondents from LMICs were more likely to administer steroids than HICs (178 vs. 78; < .001). 331 respondents (81.5%) answered that patients would receive mean arterial pressure (MAP) targeted treatment. In LMICs, SCI patients were less likely to be provided with MAP-targeted treatment (76.9%) as compared to HICs (89%; < .05). The majority of respondents (87.8%) reported that patients would benefit from early decompression. Despite overwhelming evidence and surgeons' responses that would offer early surgery, 62.4% of respondents stated they encounter logistical barriers in their institutions. This was particularly evident in LMICs, where 57.9% of respondents indicated that early intervention was unlikely to be accomplished, while only 21.1% of respondents from HICs stated the same ( < .001).
This survey highlights challenges in the implementation of standardized global practices in the management of acute SCI. Future research efforts will need to refine SCI guidelines and address barriers to guideline implementation.
横断面国际调查。
研究急性脊髓损伤（SCI）管理的当前国际实践以及指南实施的知识、采用情况和障碍。
向AO脊柱组织的成员发放调查问卷。问卷旨在获取人口统计学数据以及关于类固醇使用、血流动力学管理和手术减压时机等急性SCI治疗的常用方法。
593名成员完成了调查，包括骨科医生（54.3%）、神经外科医生（35.6%）和创伤科医生（8.4%）。大多数（61.2%）受访者来自低收入和中等收入国家（LMICs）。53.6%的医生使用类固醇治疗急性SCI。来自LMICs的受访者比高收入国家（HICs）的受访者更倾向于使用类固醇（178例对78例；P<0.001）。331名受访者（81.5%）回答患者将接受平均动脉压（MAP）目标治疗。在LMICs，与HICs相比，SCI患者接受MAP目标治疗的可能性较小（76.9%对89%；P<0.05）。大多数受访者（87.8%）报告称患者将从早期减压中获益。尽管有压倒性的证据以及外科医生支持早期手术的回应，但62.4%的受访者表示他们在所在机构遇到后勤障碍。这在LMICs中尤为明显，57.9%的受访者表示不太可能实现早期干预，而来自HICs的受访者中只有21.1%表示同样的情况（P<0.001）。
本次调查凸显了在急性SCI管理中实施标准化全球实践所面临的挑战。未来的研究工作需要完善SCI指南并解决指南实施的障碍。
