Methylprednisolone for acute spinal cord injury: 5-year practice reversal
Methylprednisolone for acute spinal cord injury: 5-year practice reversal
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DOI：
10.1017/s031716710000754x
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发表时间：
2008-03-01
影响因子：
3
通讯作者：
Hamilton, Mark G.
中科院分区：
文献类型：
--
作者：
Hurlbert, R. John;Hamilton, Mark G.
目的：在实践建议发表五年后，重新评估加拿大脊柱外科社区对急性脊髓损伤（SCI）患者使用甲基强的松龙（MP）的实践模式。方法：在各自的年度会议上对加拿大骨科和神经脊柱外科医生进行了关于急性脊髓损伤类固醇治疗实践的调查，调查问卷由五年前提出的七个问题组成，外加一个与观点改变有关的额外问题。结果：42名外科医生和21名住院医师直接参与了脊髓损伤的急性治疗。76%的脊柱外科医生不给脊髓损伤开药，而五年前这一比例为76%。在24%使用类固醇的患者中，最常采用的是NASCIS II给药方案。三分之一的医生因为害怕诉讼而继续使用MP。结论：在五年的时间里，随着对已发表文献的熟悉程度的提高，脊髓损伤的NIP管理的实践模式已经完全逆转。参加会议，参与当地小组讨论，以及同行评审的出版物，在改变由于同行压力甚至害怕诉讼而产生的实践偏好方面，似乎是有效的。
Objective: To re-evaluate practice patterns for methylprednisolone (MP) administration in patients with acute spinal cord injury (SCI) within the spinal surgery community across Canada five years after the publication of practice recommendations. Methods: Canadian orthopedic and neurological spine surgeons were surveyed at their respective annual meetings about their practice of steroid administration for acute SCI by means of a questionnaire comprised of the same seven questions posed five years ago plus an additional question related to change of view. Results: Forty-two surgeons and twenty-one residents directly involved in the acute management of SCI completed the questionnaire. Seventy-six percent of spinal surgeons do not prescribe MP for SCI in sharp contrast to 76% who prescribed it five years ago. Of the 24% who use steroids, the NASCIS II dosing regimen is most commonly followed. One third of physicians continue to administer MP because of fear of litigation. Conclusions: Over a five year period there has been a complete reversal in practice patterns of NIP administration for SCI, along with an increased familiarity of the published literature. Attendance at meetings, participation in local group discussions, and peer-reviewed publications appear effective in altering practice preferences arising from peer pressure and even fear of litigation.