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Failure of methylprednisolone to improve the outcome of spinal cord injuries
E R George1, D J Scholten, C M Buechler
1Department of Surgery, Butterworth Hospital, Grand Rapids, Michigan, USA.
Abstract:
The infusion of methylprednisolone (MP) within 8 hours of injury for spinal cord injuries (SCI) has been advocated to improve the motor function of patients after this catastrophic injury. However, clinical improvement in the outcome of SCI has not been consistently identified, despite the use of MP. We reviewed the outcome of SCI patients with MP to those without MP (No-MP) at two Level I Trauma Centers from 1989-1992. Acute SCI patients were identified from the trauma registries with trauma demographics and hospital data obtained from registry and medical records. Rehabilitation data for Functional Independence Measure (FIM) was obtained from the rehabilitation institute database. Primary outcome parameters were mortality, and for survivors, patient mobility (6 point scale) and FIM scores. There were 145 acute SCI patients: 80 treated with MP and 65 with No-MP. FIM data was available on 45 MP and 25 No-MP patients. There was no difference in the admission trauma score, ICU length of stay (LOS), or hospital LOS between the two groups. The MP patients were significantly younger (30 years vs 38 years, P = < 0.05) and had lower ISS scores (24 vs 31, P = < 0.05). There was no statistically significant difference in mortality (MP, 3.8% vs No-MP, 10.7%) between the two groups. Although admission mobility was not statistically different (MP, 5.99 vs No-MP, 5.90), there was a significantly poorer discharge mobility in the MP group when compared to the No-MP group (MP, 5.16 vs No-MP, 4.67, P = < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Methylprednisolone (MP) infusion after spinal cord injury (SCI) did not improve mortality or functional outcomes. Patients receiving MP showed poorer discharge mobility compared to those without MP treatment.
Area of Science:
- Neurosurgery
- Trauma Care
- Pharmacology
Background:
- Methylprednisolone (MP) is a corticosteroid infusion advocated for spinal cord injuries (SCI) within 8 hours of trauma.
- Despite its recommendation, clinical improvement in SCI patient outcomes has not been consistently observed.
Purpose of the Study:
- To evaluate the clinical outcomes of acute spinal cord injury (SCI) patients treated with methylprednisolone (MP) versus those without MP.
Main Methods:
- Retrospective review of 145 acute SCI patients (80 MP, 65 No-MP) from two Level I Trauma Centers (1989-1992).
- Data collected included trauma demographics, hospital length of stay (LOS), mortality, patient mobility scores, and Functional Independence Measure (FIM) scores.
Main Results:
- No significant differences in mortality (MP: 3.8% vs. No-MP: 10.7%) or admission trauma/ISS scores between groups.
- MP patients were younger (30 vs. 38 years) and had lower ISS scores (24 vs. 31).
- Significantly poorer discharge mobility was observed in the MP group (5.16) compared to the No-MP group (4.67).
Conclusions:
- Methylprednisolone (MP) administration in acute spinal cord injury (SCI) did not demonstrate improved mortality or functional outcomes.
- The study suggests potential negative impacts on mobility, warranting further investigation into MP's role in SCI management.