Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China.
Department of Orthopaedics, Tianjin Medical University General Hospital, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, 300052, P.R. China.
Spine J. 2023 Jun;23(6):888-899. doi: 10.1016/j.spinee.2022.12.001. Epub 2022 Dec 12.
Complications such as pressure sores, pulmonary infection, urinary tract infection (UTI), and venous thromboembolism (VTE) are common after spinal cord injury (SCI). These have serious consequences for patients' physical, social, and vocational well-being. Several authoritative organizations have developed guidelines for managing these complications after SCI.
We aim to systematically review and appraise guidelines on the management of four common complications (pressure sores, pulmonary infection, UTI, and VTE) after SCI as well as to summarize relevant recommendations and assess the quality of their supporting evidence.
Systematic review.
We searched Medline, Embase, Cochrane, and Web of Science, as well as guideline-specific databases (eg, National Guideline Clearinghouse) and Google Scholar, from January 2000 to January 2022. We included the most updated guidelines developed by specific authoritative organizations. We evaluated the included guidelines using the Appraisal of Guidelines for Research and Evaluation 2nd edition instrument, which measures six domains (eg, applicability). Recommendations extracted from guidelines were categorized as for, against, or neither for nor against. An evidence assessment was adopted to classify the quality of supporting evidence as poor, fair, or good.
Eleven guidelines from 2005 to 2020 were included, all of which, among the six domains, scored lowest in the domain of applicability. For pressure sores, guidelines recommended for skin inspection, repositioning, and the use of pressure reduction equipment as preventive measures and dressings, debridement, and surgery as treatment measures. For pulmonary infection, guidelines recommended for physical (eg, the use of an insufflation-exsufflation device) and pharmacological measures (eg, the use of bronchodilators). For UTI, guidelines recommended for antibiotics as a treatment measure but recommended against cranberries, methenamine salts, and acidification or alkalinization agents as preventive measures. For VTE prophylaxis, five guidelines recommended for low molecular weight heparin (LMWH). Three guidelines recommended against unfractionated heparin, whereas one guideline recommended for it. Most of the supporting evidence was of poor quality (130/139), and the rest was of fair quality (9/139).
For pressure sores, pulmonary infection, and UTI, evidence of poor to fair quality indicated consistent recommendations for prevention and treatment measures. For VTE, LMWH was consistently recommended, whereas recommendations on the use of unfractionated heparin were controversial.
脊髓损伤（SCI）后常出现压疮、肺部感染、尿路感染（UTI）和静脉血栓栓塞症（VTE）等并发症，这些并发症对患者的身体、社会和职业健康有严重影响。一些权威组织已经制定了 SCI 后并发症管理指南。
我们旨在系统地回顾和评价 SCI 后四种常见并发症（压疮、肺部感染、UTI 和 VTE）管理指南，并总结相关推荐意见，评估其证据质量。
系统综述。
我们检索了 Medline、Embase、Cochrane 和 Web of Science，以及指南专用数据库（如国家指南清理中心）和 Google Scholar，时间范围为 2000 年 1 月至 2022 年 1 月。我们纳入了特定权威组织制定的最新指南。使用评估研究和评估指南 2 版工具评估纳入的指南，该工具衡量六个领域（如适用性）。从指南中提取的推荐意见被归类为支持、反对或既不支持也不反对。采用证据评估法将支持证据的质量分类为差、中或优。
纳入了 2005 年至 2020 年的 11 项指南，在六个领域中，所有指南在适用性领域的得分最低。对于压疮，指南推荐皮肤检查、翻身和使用减压设备作为预防措施，以及使用敷料、清创和手术作为治疗措施。对于肺部感染，指南推荐物理治疗（如使用呼气-吸气装置）和药物治疗（如使用支气管扩张剂）。对于 UTI，指南推荐使用抗生素作为治疗措施，但不推荐蔓越莓、三聚氰胺盐、酸化或碱化剂作为预防措施。对于 VTE 预防，五项指南推荐使用低分子肝素（LMWH）。三项指南反对使用普通肝素，而一项指南推荐使用。大多数支持证据质量较差（130/139），其余为中等质量（9/139）。
对于压疮、肺部感染和 UTI，质量差到中等的证据表明预防和治疗措施的推荐意见一致。对于 VTE，LMWH 一直被推荐使用，而关于普通肝素的使用建议则存在争议。
