TY - JOUR
T1 - A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury
T2 - Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome Prediction
AU - Fehlings, Michael G.
AU - Martin, Allan R.
AU - Tetreault, Lindsay A.
AU - Aarabi, Bizhan
AU - Anderson, Paul
AU - Arnold, Paul M.
AU - Brodke, Darrel
AU - Burns, Anthony S.
AU - Chiba, Kazuhiro
AU - Dettori, Joseph R.
AU - Furlan, Julio C.
AU - Hawryluk, Gregory
AU - Holly, Langston T.
AU - Howley, Susan
AU - Jeji, Tara
AU - Kalsi-Ryan, Sukhvinder
AU - Kotter, Mark
AU - Kurpad, Shekar
AU - Kwon, Brian K.
AU - Marino, Ralph J.
AU - Massicotte, Eric
AU - Merli, Geno
AU - Middleton, James W.
AU - Nakashima, Hiroaki
AU - Nagoshi, Narihito
AU - Palmieri, Katherine
AU - Singh, Anoushka
AU - Skelly, Andrea C.
AU - Tsai, Eve C.
AU - Vaccaro, Alexander
AU - Wilson, Jefferson R.
AU - Yee, Albert
AU - Harrop, James S.
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by AOSpine, the Ontario Neurotrauma Foundation (ONF) and the AANS/CNS Section on Neurotrauma and Critical Care. Dr Fehlings wishes to acknowledge support from the Gerald and Tootsie Halbert Chair in Neural Repair and Regeneration and the DeZwirek Family Foundation. Dr Tetreault acknowledges support from a Krembil Postdoctoral Fellowship Award. Methodological support was provided by Spectrum Research, Inc.
Publisher Copyright:
© 2017, © The Author(s) 2017.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Introduction: The objective of this guideline is to outline the role of magnetic resonance imaging (MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI. This review focused on longitudinal studies that controlled for baseline neurologic status. A multidisciplinary Guideline Development Group (GDG) used this information, their clinical expertise, and patient input to develop recommendations on the use of MRI for SCI patients. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: Based on the limited available evidence and the clinical expertise of the GDG, our recommendations were: (1) “We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention, when feasible, to facilitate improved clinical decision-making” (quality of evidence, very low) and (2) “We suggest that MRI should be performed in adult patients in the acute period following SCI, before or after surgical intervention, to improve prediction of neurologic outcome” (quality of evidence, low). Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI.
AB - Introduction: The objective of this guideline is to outline the role of magnetic resonance imaging (MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI. This review focused on longitudinal studies that controlled for baseline neurologic status. A multidisciplinary Guideline Development Group (GDG) used this information, their clinical expertise, and patient input to develop recommendations on the use of MRI for SCI patients. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: Based on the limited available evidence and the clinical expertise of the GDG, our recommendations were: (1) “We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention, when feasible, to facilitate improved clinical decision-making” (quality of evidence, very low) and (2) “We suggest that MRI should be performed in adult patients in the acute period following SCI, before or after surgical intervention, to improve prediction of neurologic outcome” (quality of evidence, low). Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI.
KW - acute spinal cord injury
KW - clinical decision making
KW - clinical guideline
KW - guideline
KW - magnetic resonance imaging
KW - outcome prediction
KW - spinal cord injury
KW - traumatic spinal cord injury
UR - http://www.scopus.com/inward/record.url?scp=85029105002&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85029105002&partnerID=8YFLogxK
U2 - 10.1177/2192568217703089
DO - 10.1177/2192568217703089
M3 - Article
AN - SCOPUS:85029105002
SN - 2192-5682
VL - 7
SP - 221S-230S
JO - Global Spine Journal
JF - Global Spine Journal
IS - 3_supplement
ER -