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Current Practice of Methylprednisolone Administration for Acute Spinal Cord Injury in Germany: A National Survey

Druschel, Claudia, MD*,†; Schaser, Klaus-Dieter, MD; Schwab, Jan M., MD, PhD*,‡

doi: 10.1097/BRS.0b013e31828e4dce
Health Services Research

Study Design. Written mail-out survey.

Objective. To determine current practice in high-dose methylprednisolone succinate (MPSS) administration for treatment of acute spinal cord injury (SCI) in Germany.

Summary of Background Data. Reanalysis of the National Acute Spinal Cord Injury Studies (NASCIS) resulted in criticism of the use of high-dose MPSS for treatment of acute SCI. Subsequently, SCI treatment guidelines were revised leading to a reduction in MPSS use across North America. The impact of these revisions on SCI treatment in Germany is not known.

Methods. A questionnaire was sent to all trauma, orthopedic and neurosurgical departments of German university centers, affiliated teaching hospitals, and specialized SCI care centers. Survey included 6 questions about the administration of MPSS after acute SCI.

Results. Three hundred seventy-two respondents completed the survey (response rate: 51% overall, 76% university hospitals, 85% specialized SCI care centers). Overall, 55% of departments that treat SCI prescribe MPSS. Among them, 73% are “frequent” users administering MPSS to more than 50% of their patients. Ten percent prescribe according to NASCIS I, 43% NASCIS II, 33% NASCIS III, and 13% “generic protocols.” As justification for MPSS treatment, “effectiveness” ranked before “common practice” and “medicolegal reasons.” “Specialized” SCI care centers differ in that (1) MPSS is administered less frequently, (2) NASCIS I doses are not used, and (3) during the past several years, practice patterns are more likely to have shifted away from the treatment of SCI with MPSS.

Conclusion. About one-half of the institutions continue to prescribe MPSS in the setting of acute SCI. A need for further education in almost one-fourth of German departments treating acute SCI is demonstrated through responses indicating use of the outdated NASCIS I protocol, a “legal need” or “unchanged MPSS application during the last years.” “Specialized” SCI centers are more likely to change their practice in accordance with evolving literature.

Level of Evidence: 3

Critical analysis of the National Acute Spinal Cord Injury Studies challenged the use of high-dose methylprednisolone as a controversial standard of care after acute spinal cord injury due to a lack of unequivocally proven efficacy contrasted by a higher incidence of complications and higher mortality. This study assessed the current practice of methylprednisolone treatment in Germany.

*Clinical and Experimental Spinal Cord Injury Research Laboratory (Neuroparaplegiology)

Department of Musculoskeletal Surgery; and

Department of Neurology and Experimental Neurology, CHARITÉ Campus Mitte and Campus Virchow CHARITÉ - University Medicine Berlin, Germany.

Address correspondence and reprint requests to Jan Schwab, MD, PhD, Department of Neurology and Experimental Neurology, Clinical & Experimental Spinal Cord Injury Research (Neuroparaplegiology) or Claudia Druschel, MD, Department of Musculoskeletal Surgery, CHARITÉ - University Medicine Berlin CHARITÉplatz 1, D-10117 Berlin; E-mail: jan.schwab@charite.de or claudia.druschel@charite.de

Acknowledgment date: September 20, 2012. First revision date: November 7, 2012. Second revision date: January 17, 2013. Third revision date: February 8, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

German Ministry of Science and Education/Berlin - Brandenburg Center for Regenerative Therapies and Wings for Life Spinal Cord Research Foundation (No. 60-2012) funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, grants.

© 2013 by Lippincott Williams & Wilkins