A Scoping Review of Clinical Practice Guidelines for the Acute Care of Patients with Spinal Cord Injury: Respiratory, Hemodynamic and Neuroprotective Management

Abstract

Background: Given the complex nature of acute SCI management, there is a pressing need to review and evaluate existing clinical practice guidelines (CPGs). This study aims to evaluate CPGs and create a summary of recommendations related to the in-hospital acute management of SCI in three different areas: respiratory management, hemodynamic management and the use of neuroprotective agents.

Method: This study was conducted in accordance with the guidelines set by the Joanna Briggs Institute, and PRISMA-ScR. A search was conducted in thirteen databases and the gray literature. Screening and data extraction was completed by two independent reviewers against pre-specified eligibility criteria. The AGREE II tool was used to appraise the quality of the CPGs.

Results: The search identified 12 eligible studies. Seven (n=7) studies were published in the last five years. Overall, the recommendations were supported by low quality evidence. Based on the AGREE II quality appraisal, seven out of twelve CPGs can be recommended for use, and one can be recommended with modification. The following domains scored the highest average score: “Clarity of Presentation,” “Scope and Purpose,” and “Editorial Independence.” Domain 5 “Applicability” and domain 2 “Stakeholder Involvement” scored the lowest average score. While the majority of the recommendations were consistent, there were contradicting recommendations concerning the use of methylprednisolone.

Conclusion: The CPGs in the management of acute SCI are overall based on low-quality evidence. More evidence is needed to recommend for or against the use of methylprednisolone in acute SCI patients. Indeed, there is a need for the development of rigorous and up-to-date CPGs that is based on high-quality evidence.