Current Practice of Methylprednisolone Administration for Acute Spinal Cord Injury in Germany A National Survey
Current Practice of Methylprednisolone Administration for Acute Spinal Cord Injury in Germany A National Survey
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DOI：
10.1097/brs.0b013e31828e4dce
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发表时间：
2013-05-15
期刊：
影响因子：
3
通讯作者：
Schwab, Jan M.
中科院分区：
文献类型：
--
作者：
Druschel, Claudia;Schaser, Klaus-Dieter;Schwab, Jan M.
研究设计.书面邮寄调查。确定德国使用大剂量甲基强的松龙（MPSS）治疗急性脊髓损伤（SCI）的现行做法。背景资料摘要。对国家急性脊髓损伤研究（NASCIS）的再分析导致了对使用大剂量MPSS治疗急性SCI的批评。随后，SCI治疗指南进行了修订，导致整个北美MPSS的使用减少。这些修订对德国SCI治疗的影响尚不清楚。调查问卷被发送到德国大学中心，附属教学医院和专门的SCI护理中心的所有创伤，骨科和神经外科部门。调查包括6个关于急性SCI后MPSS给药的问题。372名受访者完成了调查（回复率：总体为51%，大学医院为76%，专门的SCI护理中心为85%）。总的来说，55%的SCI治疗部门开了MPSS。其中，73%是“经常”使用者，为超过50%的患者使用MPSS。10%根据NASCIS I处方，43%根据NASCIS II处方，33%根据NASCIS III处方，13%根据通用方案处方。作为MPSS治疗的理由，“有效性”排在“惯例”和“法医学原因”之前。“专业”SCI护理中心的不同之处在于（1）MPSS的使用频率较低，（2）不使用NASCIS I剂量，（3）在过去的几年中，实践模式更有可能从MPSS治疗SCI转移。约有一半的院校继续为急性脊髓损伤患者处方MPSS。近四分之一的德国急性SCI治疗部门需要进一步教育，这一点通过使用过时的NASCIS I方案、“法律的需要”或“过去几年未改变的MPSS应用”的回复得到了证明。“专业化”的SCI中心更有可能根据不断发展的文献改变他们的做法。
Study Design. Written mail-out survey.Objective. To determine current practice in high-dose methylprednisolone succinate (MPSS) administration for treatment of acute spinal cord injury (SCI) in Germany.Summary of Background Data. Reanalysis of the National Acute Spinal Cord Injury Studies (NASCIS) resulted in criticism of the use of high-dose MPSS for treatment of acute SCI. Subsequently, SCI treatment guidelines were revised leading to a reduction in MPSS use across North America. The impact of these revisions on SCI treatment in Germany is not known.Methods. A questionnaire was sent to all trauma, orthopedic and neurosurgical departments of German university centers, affiliated teaching hospitals, and specialized SCI care centers. Survey included 6 questions about the administration of MPSS after acute SCI.Results. Three hundred seventy-two respondents completed the survey (response rate: 51% overall, 76% university hospitals, 85% specialized SCI care centers). Overall, 55% of departments that treat SCI prescribe MPSS. Among them, 73% are "frequent" users administering MPSS to more than 50% of their patients. Ten percent prescribe according to NASCIS I, 43% NASCIS II, 33% NASCIS III, and 13% "generic protocols." As justification for MPSS treatment, "effectiveness" ranked before "common practice" and "medicolegal reasons." "Specialized" SCI care centers differ in that (1) MPSS is administered less frequently, (2) NASCIS I doses are not used, and (3) during the past several years, practice patterns are more likely to have shifted away from the treatment of SCI with MPSS.Conclusion. About one-half of the institutions continue to prescribe MPSS in the setting of acute SCI. A need for further education in almost one-fourth of German departments treating acute SCI is demonstrated through responses indicating use of the outdated NASCIS I protocol, a "legal need" or "unchanged MPSS application during the last years." "Specialized" SCI centers are more likely to change their practice in accordance with evolving literature.