{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T19:54:07Z","timestamp":1792007647129,"version":"4.4.0"},"reference-count":35,"publisher":"SAGE Publications","issue":"17-18","license":[{"start":{"date-parts":[[2023,8,23]],"date-time":"2023-08-23T00:00:00Z","timestamp":1692748800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:p>\n                    Immunomodulatory therapeutics represent a potential neuroprotective strategy for the management of acute spinal cord injury (SCI). One of the most intensely debated neuroprotective drugs has been methylprednisolone sodium succinate (MPSS), which was investigated initially for its role in mitigating lipid peroxidation. More recently, the anti-inflammatory\/immunomodulatory properties of MPSS have been increasingly appreciated. Over the past two decades, several systematic reviews and clinical practice guidelines related to MPSS use in SCI have been published. The goal of this study was to investigate the temporal changes in the use of steroids at North American Clinical Trials Network (NACTN) centers and to correlate these changes with the evolution in published literature and guidelines. Data on patients enrolled from 2008\u20132018 in the prospective, multi-center NACTN registry, and in whom information related to the use of steroids was available, were analyzed. Patients were stratified based on whether they received steroids or not. The primary outcome was the change in the rate of steroid use per year between 2008 and 2018. Secondary outcomes included cardiac, gastrointestinal and genitourinary (GIGU), pulmonary, and dermatological complications. We identified 608 patients, of whom 171 (28.1%) were given steroids. In 2008 and 2009, the prevailing paradigm across NACTN centers was in favor of steroid administration and as such 70% (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u200956) of patients received steroids in 2008 and 71.9% (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u200946) in 2009. An abrupt practice reversal was observed in 2010, whereby only 19.7% of patients (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u200914) received steroids, a trend that continued over subsequent years. Increasing literature in the 2000s arguing against the use of steroids culminated in the 2013 CNS\/AANS practice guidelines for the management of acute SCI. These guidelines recommended against the use of MPSS for the treatment of those with acute SCI. Over the following years (2013\u20132018), steroids continued to be an uncommonly used therapeutic option in NACTN centers (range 3.9\u201316.9%). Patients receiving steroids had significantly higher rates of pulmonary complications (87%,\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u2009147) compared with those not receiving steroids (73%,\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u2009265;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009=\u20090.0003). Compared with patients receiving steroids, however, those who did not receive steroids had significantly higher rates of cardiac (40%, [\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u2009146] versus 23%, [\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u200939]; p\u2009=\u20090.0001) and gastrointestinal\/genitourinary complications (55%, [n\u2009=\u2009189], versus 31%, [n\u2009=\u200952];\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u20090.0001). The 2013 AANS\/CNS guidelines and preceding literature appeared to have an impact on dramatically lowering the rates of corticosteroid use for acute SCI in NACTN sites after 2009. Of note, this analysis may not reflect the impact of the 2017 AO Spine Clinical Practice guidelines, which suggested the use of methylprednisolone as a valid practice option for acute SCI, especially for cervical injuries. Enhanced patient involvement in the clinical decision-making process and opportunities to personalize SCI management exist in reference to the use of MPSS in acute SCI.\n                  <\/jats:p>","DOI":"10.1089\/neu.2022.0409","type":"journal-article","created":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T01:26:08Z","timestamp":1672795568000},"page":"1938-1947","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":19,"title":["Trends in the Use of Corticosteroids in the Management of Acute Spinal Cord Injury in North American Clinical Trials Network Sites"],"prefix":"10.1177","volume":"40","author":[{"given":"Nader","family":"Hejrati","sequence":"first","affiliation":[{"name":"Division of Genetics and Development, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada."},{"name":"Division of Neurosurgery and Spine Program, Department of Surgery, and University of Toronto, Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bizhan","family":"Aarabi","sequence":"additional","affiliation":[{"name":"University of Maryland School of Medicine, Baltimore, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris J.","family":"Neal","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Ugiliweneza","sequence":"additional","affiliation":[{"name":"Kentucky Spinal Cord Injury Research Center, Louisville Kentucky, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shekar N.","family":"Kurpad","sequence":"additional","affiliation":[{"name":"Neuroscience Institute. The Medical College of Wisconsin, Milwaukee, Wisconsin, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James D.","family":"Guest","sequence":"additional","affiliation":[{"name":"The Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth G.","family":"Toups","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Houston Methodist Hospital, Houston Texas, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James S.","family":"Harrop","sequence":"additional","affiliation":[{"name":"Department of Neurological and Orthopedic Surgery, Division of Spine and Peripheral Nerve Surgery, and Delaware Valley SCI Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G.","family":"Fehlings","sequence":"additional","affiliation":[{"name":"Division of Genetics and Development, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada."},{"name":"Division of Neurosurgery and Spine Program, Department of Surgery, and University of Toronto, Toronto, Ontario, Canada."},{"name":"Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,8,23]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1991.75.1.0015"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.coph.2021.08.009"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2019.6952"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1982.57.2.0247"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/0090-3019(82)90140-9"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1984.03340250025015"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199005173222001"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03540440031029"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.sc.3100962"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2015.3963"},{"key":"e_1_3_5_12_2","first-page":"407","article-title":"Guidelines for the management of acute cervical spine and spinal cord injuries","volume":"49","author":"Hadley MN","year":"2002","unstructured":"Hadley MN, , Walters BC, , Grabb PA, et al. 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