Prevention of recurrent autonomic dysreflexia: a survey of current practice

Abstract

Objective: There is a dearth of literature on the treatment of chronic recurrent autonomic dysreflexia (AD), a well-known complication of spinal cord injury that can have life-threatening implications. This study sought to identify clinical practices regarding the treatment of AD, both acute and recurrent, in patients with spinal cord injury (SCI).

Methods: Online survey regarding AD management in SCI composed of 11 questions designed to obtain information on respondent characteristics, AD treatment options, and causes of AD.

Setting: Veterans Administration health care system.

Participants: Veterans Health Administration National SCI Staff Physicians were sent an electronic email to participate in the anonymous web-based survey.

Intervention: None applicable.

Results: The response rate was 52%. The most commonly prescribed medications for minor and severe acute manifestations of AD were nitrates. For recurrent AD, clonidine was the most commonly prescribed medication.

Interpretation: Anti-hypertensive medications continue to be the mainstay in the management of both acute and chronic recurrent AD. Current literature is lacking in prospective randomized controlled trials investigating the relative efficacy of AD interventions. Evidence-based practice guidelines are necessary to improve clinical care.

Keywords: Autonomic dysreflexia; Paraplegia; Quadriplegia; Spinal cord injuries.