The Consortium for Spinal Cord Medicine has released "Early Acute
Management in Adults with Spinal Cord Injury," a guide to managing the
critical first days after spinal cord trauma.
The guideline is published by the Paralyzed Veterans of America (PVA), which manages and funds the Consortium.
During the first few days after an SCI, when life-saving
interventions dominate the care of the spinal cord injured individual,
efforts at preserving life, limiting the severity of the injury's
effects and improving long-term outcomes are vitally important. This
guideline encompasses the myriad disciplines needed to care for a
person from the time of injury through the critical first few days of
care.
The first days after a SCI are the most crucial in terms of
survival, neuroprotection, prevention of secondary complications, and
psychosocial adjustment. Survival and Preservation of neurological
function are dependent on effective systems of immediate care within
the first 72 hours of injury. This guideline provides expert
recommendations for optimal treatment during this period.
Highlights from the Early Acute Management CPG:
- It is recommended that people with acute SCI be admitted to Level I trauma centers and later, to specialized SCI centers.
- There
is not enough evidence to support administration of neuroprotective
drugs. This includes the steroid drug methylprednisolone, commonly used
since 1990; there is insufficient proof the drug improves recovery.
- There is not enough evidence to support use of Hypothermia (cooling) after SCI.
- Early
surgery to decompress the spinal canal is recommended, although
evidence does not support this treatment as a means to improve
neurologic recovery.
- It is essential to optimal recovery to initiate
Rehabilitation interventions immediately after injury to prevent
secondary complications, including thromboembolism, Skin Breakdown,
respiratory issues and bowel and bladder care.
- It is also important to immediately begin addressing
psychosocial issues related to SCI, paying attention to Depression,
social supports, coping strategies and suicidal ideation. This is also
the key time to discuss assistive devices and information services. The
guidelines recommend that clinicians "respect expressions of hope."
Over the past decade, the Consortium's clinical practice guidelines
have been recognized as seminal works for providers of healthcare and
have achieved a worldwide audience as clinical consensus references
throughout the spinal cord medicine community. The guidelines are
prepared based on scientific and professional information; they are
reviewed by a distinguished panel of experts.
Sam Maddox, Knowledge Manager for the Reeve Foundation's Paralysis
Resource Center, has been a member of the Consortium Steering Committee
for four years.
To view the guideline in its entirety, click here.
This publication, along with nine additional Clinical Practice
Guideines and other PVA publications can be downloaded at no cost from
PVA's website: www.pva.org.
If you have any questions or comments, please contact: Rachel Hoeft,
Associate Director of Education and Research at 202-416-7651
