Current Practice of Acute Spinal Cord Injury Management: A Global Survey of Members from the AO Spine

Global Spine Journal, 2024 · DOI: 10.1177/21925682221116888 · Published: February 1, 2024

Simple Explanation

This study examines current international practices in managing acute spinal cord injuries (SCI), focusing on steroid use, blood pressure management, and surgery timing. A survey was conducted among AO Spine members to gather data on their knowledge, adoption, and barriers to implementing guidelines for acute SCI management. The survey reveals challenges in standardizing global practices for acute SCI management, particularly in low- and middle-income countries (LMICs).

Study Duration

30 days

Participants

593 members of AO Spine

Evidence Level

Cross-sectional, international survey

Key Findings

1
Steroid use for acute SCIs is more common in LMICs compared to high-income countries (HICs), despite concerns about their effectiveness and potential complications.
2
While most respondents aim for MAP-targeted treatment, LMICs are less likely to provide it due to logistical barriers like limited ICU beds.
3
Most surgeons believe in early surgical decompression, but logistical barriers, especially in LMICs, hinder its implementation.

Research Summary

This global survey reveals inconsistencies in how acute spinal cord injuries (SCI) are managed worldwide, specifically regarding steroid use, hemodynamic management, and the timing of surgery. The study highlights that surgeons in low- and middle-income countries (LMICs) face significant challenges in implementing standardized practices due to limited resources and logistical barriers. The findings emphasize the need for refining SCI guidelines and addressing practical obstacles to ensure timely and effective treatment for all patients, regardless of location.

Practical Implications

Guideline Refinement

SCI guidelines need to be updated and adapted to reflect the latest evidence and address the heterogeneity of SCI patient populations.

Resource Allocation

Increased resources and infrastructural support are needed in LMICs to improve the implementation of standardized SCI management practices.

Knowledge Transfer

Improved knowledge transfer and education are essential to bridge the gap in practice patterns between HICs and LMICs.

Study Limitations

1
Response rate of 9.1% may not fully represent all AO Spine members.
2
Clinical guidelines may vary between international and national societies.
3
Heterogeneity in defining 'early' surgery complicates the interpretation of surgical timing results.

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