FAILURE OF METHYLPREDNISOLONE TO IMPROVE THE OUTCOME OF SPINAL-CORD INJURIES

The infusion of methylprednisolone (MP) within 8 hours of injury for s pinal cord injuries (SCI) has been advocated to improve the motor func tion of patients after this catastrophic injury. However, clinical imp rovement in the outcome of SCI has not been consistently identified, d espite the use of MP. We reviewed the outcome of SCI patients with MP to those without MP (No-MP) at two Level I Trauma Centers from 1989-19 92. Acute SCI patients were identified from the trauma registries with trauma demographics and hospital data obtained from registry and medi cal records. Rehabilitation data for Functional Independence Measure ( FIM) was obtained from the rehabilitation institute database. Primary outcome parameters were mortality, and for survivors, patient mobility (6 point scale) and FIM scores. There were 145 acute SCI patients: 80 treated with MP and 65 with No-MP. FIM data was available on 45 MP an d 25 No-MP patients. There was no difference in the admission trauma s core, ICU length of stay (LOS), or hospital COS between the two groups . The MP patients were significantly younger (30 years vs 38 years, P = <0.05) and had lower ISS scores (24 vs 31, P = <0.05). There was no statistically significant difference in mortality (MP, 3.8% vs No-MP, 10.7%) between the two groups. Although admission mobility was not sta tistically different (MP, 5.99 vs No-MP, 5.90), there was a significan tly poorer discharge mobility in the MP group when compared to the No- MP group (MP, 5.16 vs No-MP, 4.67, P = <0.05). The FIM score on admiss ion to rehabilitation was not significantly different (MP, 41.24 vs No -MP, 49.71) between the two groups, and there was no significant diffe rence between the FIM stores upon discharge from rehabilitation (MP. 8 5.02 vs No-MP, 96.21). Acute SCI patients treated with MP within 8 hou rs of injury failed to show an improvement in mortality, failed to sho w an improved mobility at hospital discharge, and failed to show an im proved rehabilitation FIM score. The younger age, lower ISS, and more recent care would have favored an improvement in the outcome of the MP group. A reappraisal of the use of MP in acute SCI is warranted.