The First 72 Hours After SCI: Clinical Practice Guidelines Released

Early Acute Management in Adults with SCIThe Consortium for Spinal Cord Medicine has released "Early Acute Management in Adults with Spinal Cord Injury," a guide to managing the critical first days after spinal cord trauma.  

The guideline is published by the Paralyzed Veterans of America (PVA), which manages and funds the Consortium.  

During the first few days after an SCI, when life-saving interventions dominate the care of the spinal cord injured individual, efforts at preserving life, limiting the severity of the injury's effects and improving long-term outcomes are vitally important. This guideline encompasses the myriad disciplines needed to care for a person from the time of injury through the critical first few days of care.  

The first days after a SCI are the most crucial in terms of survival, neuroprotection, prevention of secondary complications, and psychosocial adjustment. Survival and preservation of neurological function are dependent on effective systems of immediate care within the first 72 hours of injury. This guideline provides expert recommendations for optimal treatment during this period. 

Highlights from the Early Acute Management CPG: 

  • It is recommended that people with acute SCI be admitted to Level I trauma centers and later, to specialized SCI centers. 
  • There is not enough evidence to support administration of neuroprotective drugs. This includes the steroid drug methylprednisolone, commonly used since 1990; there is insufficient proof the drug improves recovery.  
  • There is not enough evidence to support use of hypothermia (cooling) after SCI.  
  • Early surgery to decompress the spinal canal is recommended, although evidence does not support this treatment as a means to improve neurologic recovery. 
  • It is essential to optimal recovery to initiate rehabilitation interventions immediately after injury to prevent secondary complications, including thromboembolism, skin breakdown, respiratory issues and bowel and bladder care. 
  • It is also important to immediately begin addressing psychosocial issues related to SCI, paying attention to depression, social supports, coping strategies and suicidal ideation. This is also the key time to discuss assistive devices and information services. The guidelines recommend that clinicians "respect expressions of hope." 

Over the past decade, the Consortium's clinical practice guidelines have been recognized as seminal works for providers of healthcare and have achieved a worldwide audience as clinical consensus references throughout the spinal cord medicine community. The guidelines are prepared based on scientific and professional information; they are reviewed by a distinguished panel of experts. 

Sam Maddox, Knowledge Manager for the Reeve Foundation's Paralysis Resource Center, has been a member of the Consortium Steering Committee for four years.  

To view the guideline in its entirety, click here. This publication, along with nine additional Clinical Practice Guideines and other PVA publications can be downloaded at no cost from PVA's website:  www.pva.org.

If you have any questions or comments, please contact: Rachel Hoeft, Associate Director of Education and Research at 202-416-7651 or rachelh@pva.org.