Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Propensity Score-Matched Cohort Study from a Canadian Multi-Center Spinal Cord Injury Registry

Nathan Evaniew, Vanessa K. Noonan, Nader Fallah, Brian K. Kwon, Carly S. Rivers, Henry Ahn, Christopher S. Bailey, Sean D. Christie, Daryl R. Fourney, R. John Hurlbert, A. G. Linassi, Michael G. Fehlings, Marcel F. Dvorak

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

In prior analyses of the effectiveness of methylprednisolone for the treatment of patients with acute traumatic spinal cord injuries (TSCIs), the prognostic importance of patients' neurological levels of injury and their baseline severity of impairment has not been considered. Our objective was to determine whether methylprednisolone improved motor recovery among participants in the Rick Hansen Spinal Cord Injury Registry (RHSCIR). We identified RHSCIR participants who received methylprednisolone according to the Second National Spinal Cord Injury Study (NASCIS-II) protocol and used propensity score matching to account for age, sex, time of neurological exam, varying neurological level of injury, and baseline severity of neurological impairment. We compared changes in total, upper extremity, and lower extremity motor scores using the Wilcoxon signed-rank test and performed sensitivity analyses using negative binomial regression. Forty-six patients received methylprednisolone and 1555 received no steroid treatment. There were no significant differences between matched participants for each of total (13.7 vs. 14.1, respectively; p=0.43), upper extremity (7.3 vs. 6.4; p=0.38), and lower extremity (6.5 vs. 7.7; p=0.40) motor recovery. This result was confirmed using a multivariate model and, as predicted, only cervical (C1-T1) rather than thoracolumbar (T2-L3) injury levels (p<0.01) and reduced baseline injury severity (American Spinal Injury Association [ASIA] Impairment Scale grades; p<0.01) were associated with greater motor score recovery. There was no in-hospital mortality in either group; however, the NASCIS-II methylprednisolone group had a significantly higher rate of total complications (61% vs. 36%; p=0.02) NASCIS-II methylprednisolone did not improve motor score recovery in RHSCIR patients with acute TSCIs in either the cervical or thoracic spine when the influence of anatomical level and severity of injury were included in the analysis. There was a significantly higher rate of total complications in the NASCIS-II methylprednisolone group. These findings support guideline recommendations against routine administration of methylprednisolone in acute TSCI.

Original languageEnglish (US)
Pages (from-to)1674-1683
Number of pages10
JournalJournal of Neurotrauma
Volume32
Issue number21
DOIs
StatePublished - Nov 1 2015
Externally publishedYes

Fingerprint

Propensity Score
Methylprednisolone
Spinal Cord Injuries
Registries
Cohort Studies
Wounds and Injuries
Therapeutics
Upper Extremity
Lower Extremity
Nonparametric Statistics
Hospital Mortality
Spine
Thorax
Steroids
Guidelines

Keywords

  • methylprednisolone
  • motor score
  • neurological recovery
  • propensity scored-matched
  • spinal cord injury

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries : A Propensity Score-Matched Cohort Study from a Canadian Multi-Center Spinal Cord Injury Registry. / Evaniew, Nathan; Noonan, Vanessa K.; Fallah, Nader; Kwon, Brian K.; Rivers, Carly S.; Ahn, Henry; Bailey, Christopher S.; Christie, Sean D.; Fourney, Daryl R.; Hurlbert, R. John; Linassi, A. G.; Fehlings, Michael G.; Dvorak, Marcel F.

In: Journal of Neurotrauma, Vol. 32, No. 21, 01.11.2015, p. 1674-1683.

Research output: Contribution to journalArticle

Evaniew, N, Noonan, VK, Fallah, N, Kwon, BK, Rivers, CS, Ahn, H, Bailey, CS, Christie, SD, Fourney, DR, Hurlbert, RJ, Linassi, AG, Fehlings, MG & Dvorak, MF 2015, 'Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Propensity Score-Matched Cohort Study from a Canadian Multi-Center Spinal Cord Injury Registry', Journal of Neurotrauma, vol. 32, no. 21, pp. 1674-1683. https://doi.org/10.1089/neu.2015.3963
Evaniew, Nathan ; Noonan, Vanessa K. ; Fallah, Nader ; Kwon, Brian K. ; Rivers, Carly S. ; Ahn, Henry ; Bailey, Christopher S. ; Christie, Sean D. ; Fourney, Daryl R. ; Hurlbert, R. John ; Linassi, A. G. ; Fehlings, Michael G. ; Dvorak, Marcel F. / Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries : A Propensity Score-Matched Cohort Study from a Canadian Multi-Center Spinal Cord Injury Registry. In: Journal of Neurotrauma. 2015 ; Vol. 32, No. 21. pp. 1674-1683.
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N2 - In prior analyses of the effectiveness of methylprednisolone for the treatment of patients with acute traumatic spinal cord injuries (TSCIs), the prognostic importance of patients' neurological levels of injury and their baseline severity of impairment has not been considered. Our objective was to determine whether methylprednisolone improved motor recovery among participants in the Rick Hansen Spinal Cord Injury Registry (RHSCIR). We identified RHSCIR participants who received methylprednisolone according to the Second National Spinal Cord Injury Study (NASCIS-II) protocol and used propensity score matching to account for age, sex, time of neurological exam, varying neurological level of injury, and baseline severity of neurological impairment. We compared changes in total, upper extremity, and lower extremity motor scores using the Wilcoxon signed-rank test and performed sensitivity analyses using negative binomial regression. Forty-six patients received methylprednisolone and 1555 received no steroid treatment. There were no significant differences between matched participants for each of total (13.7 vs. 14.1, respectively; p=0.43), upper extremity (7.3 vs. 6.4; p=0.38), and lower extremity (6.5 vs. 7.7; p=0.40) motor recovery. This result was confirmed using a multivariate model and, as predicted, only cervical (C1-T1) rather than thoracolumbar (T2-L3) injury levels (p<0.01) and reduced baseline injury severity (American Spinal Injury Association [ASIA] Impairment Scale grades; p<0.01) were associated with greater motor score recovery. There was no in-hospital mortality in either group; however, the NASCIS-II methylprednisolone group had a significantly higher rate of total complications (61% vs. 36%; p=0.02) NASCIS-II methylprednisolone did not improve motor score recovery in RHSCIR patients with acute TSCIs in either the cervical or thoracic spine when the influence of anatomical level and severity of injury were included in the analysis. There was a significantly higher rate of total complications in the NASCIS-II methylprednisolone group. These findings support guideline recommendations against routine administration of methylprednisolone in acute TSCI.

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