Consequences of high-dose steroid therapy for acute spinal cord injury

Objective: High-dose Solu-Medrol (Upjohn, Kalamazoo, Mich) therapy has become standard care in the management of acute spinal cord injury (ASCI), This study attempts to define the adverse effects that Solu-Medrol therapy has on these patients. Design: Retrospective review with historical control. Material and Methods: From May 1990 to April 1994, all patients with ASCI admitted within 8 hours of injury received high-dose Solu-Medrol per the National Acute Spinal Injury Study (NASCIS-2) protocol, Their demographic and outcome parameters were compared with those of a group admitted from March 1986 to December 1993 with an associated ASCI who received no steroid therapy. Measurements and Main Results: Steroid therapy was associated with a 2.6-fold increase in the incidence of pneumonia and an increase in ventilated and intensive care days, However, it was associated with a decrease in duration of rehabilitation and had no significant impact on other outcome parameters, including mortality. Conclusions: Although the NASCIS-2 protocol may promote early infectious complications, it has no adverse impact on longterm outcome in patients with ASCIs.