A critical appraisal of clinical practice guidelines for management of four common complications after spinal cord injury

Zheng, Ruiyuan; Guan, Bin; Fan, Yuxuan; Fu, Runhan; Yao, Liang; Wang, Wei; Li, Guoyu; Chen, Lingxiao; Zhou, Hengxing; Feng, Shiqing

doi:10.1016/j.spinee.2022.12.001

Cited by 10 publications

(8 citation statements)

References 46 publications

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“…We previously conducted a comprehensive evaluation of clinical practice guidelines for SCI. [8][9][10][11] We found that some of the recommendations in diagnosis, treatment and complications management after SCI in the domestic and international guidelines lack rigour and clarity, and the feasibility of guidance for clinical practice is insufficient (eg, the lack of uniform and clear clinical management criteria, optimal imaging criteria and optimal surgical criteria). [8][9][10][11][12][13][14][15] To optimise the current clinical treatments for SCI, we need to develop a comprehensive and systematic assessment of the current status of clinical management of SCI.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Protocol for the Chinese Real-World Evidence for Acute Spinal Cord Injury (ChiRES) study: a prospective, observational, multicentre cohort study of acute spinal cord injury

Yuan,

Sun,

et al. 2024

BMJ Open

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IntroductionSpinal cord injury (SCI) is a catastrophic event with devastating physical, social and occupational consequences for patients and their families. The number of patients with acute SCI in China continues to grow rapidly, but there have been no large prospective cohort studies of patients with acute SCI. This proposed study aims to establish a multicentre, extensive sample cohort of clinical data and biological samples of patients in China, which would aid the systematisation and standardisation of clinical research and treatment of acute SCI, thus reducing the heavy burden of acute SCI on patients and society.Methods and analysisThe Chinese Real-World Evidence for Acute Spinal Cord Injury (ChiRES) study is an observational, multicentre cohort study of patients with acute SCI admitted to the Qilu Hospital of Shandong University and other participating centres with prospective collection of their clinical data and biological samples. We aim to recruit 2097 patients in this study. Demographics, disease history, emergency intervention information, motor and sensory examinations, surgical information, medication information and rehabilitation evaluation will be recorded. This will facilitate the development of a prediction model for complications and prognosis of patients with acute SCI and an evaluation of the current management of acute SCI. Among these variables, detailed information on surgical treatment will also be used to assess procedures for acute SCI treatment. Outcome measurements, including the International Standard for Neurological Classification of Spinal Cord Injury examinations, the occurrence of complications and death, will be performed repeatedly during follow-up. We will analyse imaging data and blood samples to develop SCI imaging markers and biomarkers.Ethics and disseminationThis study protocol has been approved by the Medical Ethics Committee of the Qilu Hospital of Shandong University and all other participating centres. The findings will be disseminated in peer-reviewed journals and academic conferences.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Protocol for the Chinese Real-World Evidence for Acute Spinal Cord Injury (ChiRES) study: a prospective, observational, multicentre cohort study of acute spinal cord injury

Yuan,

Sun,

et al. 2024

BMJ Open

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“…Patients with SCI are at high risk for complications in the ICU and acute care settings including venous thromboembolism, ileus, pressure injuries, and pulmonary and urinary tract infections. 119 For venous thromboembolism prevention, current guidelines recommend, in addition to mechanical measures, initiating pharmacologic prophylaxis (preferably low-molecular-weight heparin) within 72 hours of SCI and continuing through 12 weeks, when the risk for venous thromboembolism declines. 119 Guidance regarding the empiric use of inferior vena cava filters for CASE 7-3 A 77-year-old man with a history of arthritis fell at home and presented to a local emergency department with upper extremity numbness and weakness.…”

Section: Supportive Care and Mitigation Of Secondary Injurymentioning

confidence: 99%

Traumatic Brain Injury and Traumatic Spinal Cord Injury

Podell,

Morris

2024

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE This article reviews the mechanisms of primary traumatic injury to the brain and spinal cord, with an emphasis on grading severity, identifying surgical indications, anticipating complications, and managing secondary injury. LATEST DEVELOPMENTS Serum biomarkers have emerged for clinical decision making and prognosis after traumatic injury. Cortical spreading depolarization has been identified as a potentially modifiable mechanism of secondary injury after traumatic brain injury. Innovative methods to detect covert consciousness may inform prognosis and enrich future studies of coma recovery. The time-sensitive nature of spinal decompression is being elucidated. ESSENTIAL POINTS Proven management strategies for patients with severe neurotrauma in the intensive care unit include surgical decompression when appropriate, the optimization of perfusion, and the anticipation and treatment of complications. Despite validated models, predicting outcomes after traumatic brain injury remains challenging, requiring prognostic humility and a model of shared decision making with surrogate decision makers to establish care goals. Penetrating injuries, especially gunshot wounds, are often devastating and require public health and policy approaches that target prevention.

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“…The worldwide incidence of SCI is estimated to be between 250,000 and 500,000 persons annually. [1][2][3] Despite numerous fundamental scientific and clinical breakthroughs in the treatment of SCI, currently, there is a deficiency of a solitary efficient therapeutic strategy to avert the severe paralysis linked with this type of injury. SCI frequently occurs in two stages.…”

Section: Introductionmentioning

confidence: 99%

“…Spinal cord injury (SCI), one of the most incapacitating neurological disorders that can result in limited movement, pain, and dysfunction of the autonomic nervous system, is a significant global issue in terms of public health. The worldwide incidence of SCI is estimated to be between 250,000 and 500,000 persons annually 1–3 . Despite numerous fundamental scientific and clinical breakthroughs in the treatment of SCI, currently, there is a deficiency of a solitary efficient therapeutic strategy to avert the severe paralysis linked with this type of injury.…”

Section: Introductionmentioning

confidence: 99%

Role of durotomy on function outcome, tissue sparing, inflammation, and tissue stiffness after spinal cord injury in rats

Jin,

Wang,

Ren

et al. 2024

MedComm

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Currently, there is a lack of effective treatments for spinal cord injury (SCI), a debilitating medical condition associated with enduring paralysis and irreversible neuronal damage. Extradural decompression of osseous as well as soft tissue components has historically been the principal objective of surgical procedures. Nevertheless, this particular surgical procedure fails to tackle the intradural compressive alterations that contribute to secondary SCI. Here, we propose an early intrathecal decompression strategy and evaluate its role on function outcome, tissue sparing, inflammation, and tissue stiffness after SCI. Durotomy surgery significantly promoted recovery of hindlimb locomotor function in an open‐field test. Radiological analysis suggested that lesion size and tissue edema were significantly reduced in animals that received durotomy. Relative to the group with laminectomy alone, the animals treated with a durotomy had decreased cavitation, scar formation, and inflammatory responses at 4 weeks after SCI. An examination of the mechanical properties revealed that durotomy facilitated an expeditious restoration of the injured tissue's elastic rigidity. In general, early decompressive durotomy could serve as a significant strategy to mitigate the impairments caused by secondary injury and establish a more conducive microenvironment for prospective cellular or biomaterial transplantation.

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A critical appraisal of clinical practice guidelines for management of four common complications after spinal cord injury

Cited by 10 publications

References 46 publications

Protocol for the Chinese Real-World Evidence for Acute Spinal Cord Injury (ChiRES) study: a prospective, observational, multicentre cohort study of acute spinal cord injury

Protocol for the Chinese Real-World Evidence for Acute Spinal Cord Injury (ChiRES) study: a prospective, observational, multicentre cohort study of acute spinal cord injury

Traumatic Brain Injury and Traumatic Spinal Cord Injury

Role of durotomy on function outcome, tissue sparing, inflammation, and tissue stiffness after spinal cord injury in rats

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