Gerhart K A, Johnson R L, Menconi J, Hoffman R E, Lammertse D P
Craig Hospital, Rocky Mountain Regional Spinal Injury System, Englewood, Colorado, USA.
Paraplegia. 1995 Jun;33(6):316-21. doi: 10.1038/sc.1995.71.
The announcement and publication of the second National Acute Spinal Cord Injury Study (NASCIS II) project's findings regarding the role of high dose methylprednisolone in improving neurological outcomes following acute traumatic spinal cord injury generated widespread excitement and interest. To determine the association between this interest and actual use and implementation of the protocol, Colorado's comprehensive population-based spinal cord injury surveillance data were examined. The medical records of 218 SCI survivors injured between May 1, 1990 and December 31, 1991, and of 145 persons spinal cord injured 2 years later, during 1993, were reviewed to determine the rapidity and extent of NASCIS II implementation by Colorado's hospitals, factors associated with use and non-use of the protocol, changing usage trends over time, and the short term neurological outcomes of patients who received the protocol. Clear documentation of the protocol's usage was present for only 46% of the reported patients' medical records in 1990-91, and 61% in 1993. Small, emergency triage facilities were significantly more likely to use the protocol than larger acute care hospitals, and patients with initially incomplete injuries were less likely to receive the drug. There were no significant differences in neurological outcomes, using the Frankel classification system, between those who received the protocol and those who did not. The limitations and implications of these findings are discussed.
第二项全国急性脊髓损伤研究（NASCIS II）项目公布了关于大剂量甲基强的松龙在改善急性创伤性脊髓损伤后神经功能结果方面作用的研究结果，这引起了广泛的关注和兴趣。为了确定这种关注与该方案的实际使用和实施之间的关联，研究人员审查了科罗拉多州基于人群的全面脊髓损伤监测数据。研究人员查阅了1990年5月1日至1991年12月31日期间受伤的218名脊髓损伤幸存者以及1993年（即两年后）受伤的145人的医疗记录，以确定科罗拉多州医院实施NASCIS II的速度和程度、与该方案使用和未使用相关的因素、随时间变化的使用趋势，以及接受该方案治疗的患者的短期神经功能结果。在1990 - 1991年报告的患者医疗记录中，只有46%有该方案使用的明确记录，1993年这一比例为61%。小型急诊分诊机构比大型急性护理医院更有可能使用该方案，而最初损伤不完全的患者接受该药物治疗的可能性较小。使用Frankel分类系统，接受该方案治疗的患者和未接受该方案治疗的患者在神经功能结果方面没有显著差异。本文讨论了这些研究结果的局限性和意义。
