Failure to administer methylprednisolone for acute traumatic spinal cord injury-a prospective audit of 100 patients from a regional spinal injuries unit

Injury. 2002 Sep;33(7):575-8. doi: 10.1016/s0020-1383(02)00142-0.


Overview: The National Acute Spinal Cord Injury Studies (NASCIS II and III) and the Cochrane review advocate the administration of high dose methylprednisolone following acute traumatic spinal cord injury.

Objective: To determine the actual use and correct implementation of the NASCIS protocols in patients referred to a regional spinal injuries unit.

Design: Observational study on the timing and correct dosage of methylprednisolone. The admission Frankel grade, American Spinal Injury Association (ASIA) neurological classification were recorded prospectively.

Subjects: The 100 consecutive patients with complete or incomplete spinal cord injuries (Frankel grade A-D) were studied over a 2 years period.

Main outcome measure: Correct administration of methylprednisolone according to the NASCIS protocols.

Results: During the study period only 25% of the patients admitted to our spinal injuries unit received methylprednisolone at the referring hospital according to the NASCIS protocols. An additional 10 patients were given methylprednisolone incorrectly.

Conclusion: Evidence based medicine is not being practiced in the management of patients with acute spinal cord injury.

MeSH terms

  • Acute Disease
  • Adult
  • Anti-Inflammatory Agents / administration & dosage*
  • Cervical Vertebrae / injuries
  • Clinical Protocols
  • Confidence Intervals
  • Drug Administration Schedule
  • England
  • Female
  • Humans
  • Intensive Care Units
  • Lumbar Vertebrae
  • Male
  • Medical Audit
  • Methylprednisolone / administration & dosage*
  • Neuroprotective Agents / administration & dosage*
  • Prospective Studies
  • Spinal Cord Injuries / drug therapy*


  • Anti-Inflammatory Agents
  • Neuroprotective Agents
  • Methylprednisolone