Adherence to international guidelines in neurocritical care of cervical traumatic spinal cord injury-a retrospective study
Introduction: The American Association of Neurologic Surgeons guidelines on the management of traumatic spinal cord injury (SCI), updated in 2013, focus on spinal cord perfusion, early decompressive surgery, and venous thromboembolism (VTE) prophylaxis to improve neurological outcome. Research quest...
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| Language: | English |
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Elsevier
2024-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529424000778 |
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| author | Fredrika Rask Erik Uvelius Niklas Marklund |
| author_facet | Fredrika Rask Erik Uvelius Niklas Marklund |
| author_sort | Fredrika Rask |
| collection | DOAJ |
| description | Introduction: The American Association of Neurologic Surgeons guidelines on the management of traumatic spinal cord injury (SCI), updated in 2013, focus on spinal cord perfusion, early decompressive surgery, and venous thromboembolism (VTE) prophylaxis to improve neurological outcome. Research question: How neurocritical care and initial management have changed with the implementation of updated management guidelines, focusing on guidelines adherence and neurological outcome. Material and methods: Systemic physiological variables, time to neurosurgical treatment and VTE prophylaxis, and neurological outcome, were retrospectively collected from adult patients treated for cervical SCI 2001–2021. Results: Fifty-two patients were included. Mean arterial blood pressure (MAP) was significantly higher after 2013 (86±9.9 mmHg) when compared to before 2013 (79±9.9 mmHg), p = 0.041. Median time to surgery was 41 h before, and 20 h after 2013 (p = 0.029). Time to VTE prophylaxis was six days before and four days after 2013. Most neurocritical care complications were less commonly observed after 2013. Despite improved adherence to treatment goals, 44 % of MAP levels were below target, and 33% of patients were operated beyond 24h post-injury. Neurological outcome was not improved after implementation of the revised guidelines. Discussion and conclusion: While implementation of the revised 2013 guidelines improved most aspects of the acute SCI management, many guideline targets were not met in a large subset of patients. Strict adherence to the acute neurocritical management goals, and early surgical treatment, is likely crucial when aiming to improve SCI outcome. |
| format | Article |
| id | doaj-art-667e04734fa04334977885c5b6fcaad0 |
| institution | OA Journals |
| issn | 2772-5294 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj-art-667e04734fa04334977885c5b6fcaad02025-08-20T01:56:20ZengElsevierBrain and Spine2772-52942024-01-01410282110.1016/j.bas.2024.102821Adherence to international guidelines in neurocritical care of cervical traumatic spinal cord injury-a retrospective studyFredrika Rask0Erik Uvelius1Niklas Marklund2Department of Clinical Sciences Lund, Neurosurgery, Lund University, Lund, SwedenDepartment of Clinical Sciences Lund, Neurosurgery, Lund University, Lund, SwedenDepartment of Clinical Sciences Lund, Neurosurgery, Lund University, Skåne University Hospital, Lund, Sweden; Corresponding author. Skåne University Hospital EA-blocket plan 4 Entrégatan 7, 222 42 Lund. Sweden.Introduction: The American Association of Neurologic Surgeons guidelines on the management of traumatic spinal cord injury (SCI), updated in 2013, focus on spinal cord perfusion, early decompressive surgery, and venous thromboembolism (VTE) prophylaxis to improve neurological outcome. Research question: How neurocritical care and initial management have changed with the implementation of updated management guidelines, focusing on guidelines adherence and neurological outcome. Material and methods: Systemic physiological variables, time to neurosurgical treatment and VTE prophylaxis, and neurological outcome, were retrospectively collected from adult patients treated for cervical SCI 2001–2021. Results: Fifty-two patients were included. Mean arterial blood pressure (MAP) was significantly higher after 2013 (86±9.9 mmHg) when compared to before 2013 (79±9.9 mmHg), p = 0.041. Median time to surgery was 41 h before, and 20 h after 2013 (p = 0.029). Time to VTE prophylaxis was six days before and four days after 2013. Most neurocritical care complications were less commonly observed after 2013. Despite improved adherence to treatment goals, 44 % of MAP levels were below target, and 33% of patients were operated beyond 24h post-injury. Neurological outcome was not improved after implementation of the revised guidelines. Discussion and conclusion: While implementation of the revised 2013 guidelines improved most aspects of the acute SCI management, many guideline targets were not met in a large subset of patients. Strict adherence to the acute neurocritical management goals, and early surgical treatment, is likely crucial when aiming to improve SCI outcome.http://www.sciencedirect.com/science/article/pii/S2772529424000778Spinal cord injuryMonitoringNeurocritical careMean arterial blood pressureOutcome |
| spellingShingle | Fredrika Rask Erik Uvelius Niklas Marklund Adherence to international guidelines in neurocritical care of cervical traumatic spinal cord injury-a retrospective study Brain and Spine Spinal cord injury Monitoring Neurocritical care Mean arterial blood pressure Outcome |
| title | Adherence to international guidelines in neurocritical care of cervical traumatic spinal cord injury-a retrospective study |
| title_full | Adherence to international guidelines in neurocritical care of cervical traumatic spinal cord injury-a retrospective study |
| title_fullStr | Adherence to international guidelines in neurocritical care of cervical traumatic spinal cord injury-a retrospective study |
| title_full_unstemmed | Adherence to international guidelines in neurocritical care of cervical traumatic spinal cord injury-a retrospective study |
| title_short | Adherence to international guidelines in neurocritical care of cervical traumatic spinal cord injury-a retrospective study |
| title_sort | adherence to international guidelines in neurocritical care of cervical traumatic spinal cord injury a retrospective study |
| topic | Spinal cord injury Monitoring Neurocritical care Mean arterial blood pressure Outcome |
| url | http://www.sciencedirect.com/science/article/pii/S2772529424000778 |
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