Wednesday, April 17, 2013

Neurosurgery's Takedown of Steroids in SCI

A brave new day dawns – clinicians who otherwise lived in fear of medicolegal reprisal from failing to administer steroids in acute spinal cord trauma may now safely withhold them.

The steroids in spinal cord debate, a one-man crusade lead by Michael Bracken, distorted by performing Cochrane Reviews of his own articles, has hopefully been definitively settled.  These authors, as part of a comprehensive update on the diagnosis and management of acute spinal cord injury, definitively summarize the flawed literature supporting methylprednisolone administration.  Their recommendation:

Administration of methylprednisolone (MP) for the treatment of acute spinal cord injury (SCI) is not recommended. Clinicians considering MP therapy should bear in mind that the drug is not Food and Drug Administration (FDA) approved for this application. There is no Class I or Class II medical evidence supporting the clinical benefit of MP in the treatment of acute SCI. Scattered reports of Class III evidence claim inconsistent effects likely related to random chance or selection bias. However, Class I, II, and III evidence exists that high-dose steroids are associated with harmful side effects including death. 

We've come a long way since the NIH faxed a letter to every Emergency Department in the country instructing physicians to give steroids.  Another amazing saga demonstrating the danger of inadequately reviewed medical evidence.

"Pharmacological Therapy for Acute Spinal Cord Injury"
http://www.ncbi.nlm.nih.gov/pubmed/23417182

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