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Published on: December 17, 2014
Methylprednisolone Therapy in Acute Traumatic Spinal Cord Injury: Analysis of a Regional Spinal Cord Model Systems
Jacob E Sunshine1, Armagan Dagal, Stephen P Burns
1From the *Department of Anesthesiology and Pain Medicine, University of Washington, Seattle; †Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, Washington; ‡Spinal Cord Injury Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Departments of §Rehabilitation and ‖Neurosurgery, Harborview Medical Center, University of Washington, Seattle, Washington.
Background:
The objective of this study was to assess the relationship between exposure to methylprednisolone (MP) and improvements in motor function among patients with acute traumatic spinal cord injury (TSCI). MP therapy for patients with TSCI is controversial because of the current conflicting evidence documenting its benefits and risks.
Methods:
We conducted a retrospective cohort study from September 2007 to November 2014 of 311 patients with acute TSCI who were enrolled into a model systems database of a regional, level I trauma center. We linked outcomes and covariate data from the model systems database with MP exposure data from the electronic medical record. The primary outcomes were rehabilitation discharge in American Spinal Injury Association (ASIA) motor scores (sum of 10 key muscles bilaterally as per International Standards for Neurological Classification of Spinal Cord Injury, range, 0-100) and Functional Independence Measure (FIM) motor scores (range, 13-91). Secondary outcomes measured infection risk and gastrointestinal (GI) complications among MP recipients. For the primary outcomes, multivariable linear regression was used.
Results:
There were 160 MP recipients and 151 nonrecipients. Adjusting for age, sex, weight, race, respective baseline motor score, surgical intervention, injury level, ASIA Impairment Scale (AIS) grade, education, and insurance status, there was no association with improvement in discharge ASIA motor function or FIM motor score among MP recipients: -0.34 (95% CI, -2.8, 2.1) and 0.75 (95% CI, -2.8, 4.3), respectively. Adjusting for age, sex, race, weight, injury level, and receipt of surgery, no association with increased risk of infection or GI complications was observed.
Conclusions:
This retrospective cohort study involving patients with acute TSCI observed no short-term improvements in motor function among MP recipients compared with nonrecipients. Our findings support current recommendations that MP use in this population should be limited.
