BACKGROUND CONTEXT

Spinal cord injury brings devastating consequences and huge economic burden. Different authoritative organizations have developed different guidelines for pharmacological treatments of spinal cord injury, but there is a lack of a critical appraisal of them.

PURPOSE

To systematically review and appraise guidelines regarding their recommendations for pharmacological treatments for spinal cord injury.

STUDY DESIGN

Systematic review.

METHODS

We searched Medline, Embase, Cochrane, and Web of Science from January 2000 to January 2022 as well as guideline-specific databases (eg, Congress of Neurological Surgeons) and Google Scholar. We included the most updated guideline containing evidence-based recommendations or consensus-based recommendations developed by specific authoritative organizations if multiple versions were available. We appraised guidelines through the Appraisal of Guidelines for Research and Evaluation, 2nd edition instrument consisting of six domains (eg, applicability). With supporting evidence, recommendations were classified as: for, against, neither for nor against. We utilized an evidence assessment system to categorize the quality of supporting evidence as poor, fair, or good.

RESULTS

Eight guidelines developed from 2008 to 2020 were included, but all of them scored lowest in the domain of applicability among all six domains. Twelve pharmacological agents (eg, methylprednisolone) were studied. For methylprednisolone, three guidelines (3/8=37.5%) recommended for (one evidence-based and two consensus-based), three (3/8=37.5%) recommended against (all evidence-based), and two (2/8=25%) recommended neither for nor against. For monosialotetrahexosylganglioside (GM-1), one guideline (1/4=25%) recommended for (consensus-based), one (1/4=25%) recommended against (evidence-based), and two (2/4=50%) recommended neither for nor against. For other agents (eg, minocycline), most guidelines (3/5=60%) recommended neither for nor against, one (1/5=20%) recommended against naloxone (evidence-based) and nimodipine (evidence-based), and one (1/5=20%) recommended for neural growth factor (consensus-based). The quality of most of the supporting evidence was poor, and the rest was fair.

CONCLUSIONS

There were inconsistencies among recommendations for methylprednisolone and GM-1. Evidence-based recommendations tended to recommend against, whereas consensus-based recommendations tended to recommend for.

中文翻译：

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对脊髓损伤药物治疗临床实践指南的批判性评价

背景语境

脊髓损伤带来毁灭性的后果和巨大的经济负担。不同的权威组织对脊髓损伤的药物治疗制定了不同的指南，但缺乏对它们的批判性评价。

目的

系统地审查和评估有关脊髓损伤药物治疗建议的指南。

学习规划

系统审查。

方法

我们搜索了 2000 年 1 月至 2022 年 1 月期间的 Medline、Embase、Cochrane 和 Web of Science 以及特定于指南的数据库（例如，神经外科医生大会）和 Google 学术搜索。如果有多个版本可用，我们包括了最新的指南，其中包含由特定权威组织制定的基于证据的建议或基于共识的建议。我们通过研究和评估指南的评估评估指南，第二版工具由六个领域（例如，适用性）组成。根据支持证据，建议分为：支持、反对、既不支持也不反对。我们利用证据评估系统将支持证据的质量分为差、一般或好。

结果

包括 2008 年至 2020 年制定的八项指南，但所有指南在所有六个领域中的适用性领域得分最低。研究了 12 种药物（例如甲泼尼龙）。对于甲泼尼龙，三项指南 (3/8=37.5%) 推荐（一项基于证据，两项基于共识），三项 (3/8=37.5%) 反对（全部基于证据），两项 (2/ 8=25%）既不赞成也不反对。对于单唾液酸四己糖神经节苷脂 (GM-1)，一项指南 (1/4=25%) 推荐（基于共识），一项 (1/4=25%) 推荐反对（基于证据），两项 (2/4= 50%) 既不赞成也不反对。对于其他药物（例如，米诺环素），大多数指南 (3/5=60%) 既不推荐也不反对，一个 (1/5=20%) 建议反对纳洛酮（基于证据）和尼莫地平（基于证据），一个 (1/5=20%) 推荐用于神经生长因子（基于共识）。大多数支持证据的质量很差，其余的则一般。

结论

甲泼尼龙和 GM-1 的推荐意见不一致。基于证据的建议倾向于反对，而基于共识的建议倾向于推荐。