Use and determinants of the methylprednisolone protocol for traumatic spinal cord injury in South Carolina acute care hospitals

Abstract

Background: The use of methylprednisolone sodium succinate (MPSS) in the treatment of traumatic spinal cord injury was initially reported to enhance recovery in the National Acute Spinal Cord Injury Studies (NASCIS), 1990 and 1997. Controversy led to subsequent research and a 2002 report citing insufficient evidence for MPSS treatment standards or guidelines. Our purpose was to explore emergency department (ED) response to this shifting information by assessing the impact of NASCIS and the 2002 report on MPSS protocols and to study factors associated with MPSS administration.

Methods: Availability of protocols and hospital characteristics were determined by survey of all hospitals with EDs in South Carolina. Protocol copies were obtained and reviewed for accuracy based on NASCIS. Patient hospital discharge information was collected through the state Office of Research and Statistics, and factors associated with receiving MPSS were evaluated using multivariable techniques.

Results: Having a protocol was associated with trauma level designation and volume of traumatic spinal cord injury patients per annum, with 100% of Level I trauma facilities having a protocol. Across all trauma levels, 40% of reporting EDs had an MPSS protocol, with 86% of these accurate, and none withdrawn during the study. Patient factors associated with being less likely to receive MPSS were female gender, injury below thoracic level, and treatment in an undesignated trauma center.

Conclusions: Shifting information on the benefit of MPSS did not lead to withdrawal of protocols over the study time period. However, within those hospitals having a protocol, only 32% of eligible patients received MPSS treatment.