A Canadian national survey of the medical management of acute traumatic spinal cord injury.
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BACKGROUND: The management of patients with acute traumatic spinal cord injury (SCI) remains a significant challenge, with ongoing debate surrounding the optimal targets for mean arterial pressure (MAP), spinal cord perfusion pressure (SCPP), and hemoglobin (Hb) transfusion thresholds. This study aimed to identify areas of consensus and discordance in the management strategies employed by Canadian healthcare providers caring for patients with acute SCI. METHODS: A comprehensive multi-stage survey was developed and administered to healthcare providers actively involved in the management of acute SCI, including neurosurgeons, orthopedic surgeons, intensive care specialists, trauma surgeons, and emergency medicine physicians. The survey assessed preferences related to MAP, SCPP, and Hb transfusion thresholds, as well as opinions on the need for future research in this area. RESULTS: A total of 71 healthcare providers completed the survey, with a 100% completion rate. The majority of participants were from neurosurgery (38.1%), intensive care (31.0%), and orthopedics (25.4%). While 75.7% of participants routinely set a MAP target, only 7.1% set an SCPP target. The most common Hb transfusion threshold was <7 g/dL (50.7%) for patients with neurological deficits, with the majority (62.3%) maintaining this threshold for all patients. A significant proportion (15.9%) would consider transfusing based on clinical status alone, regardless of the Hb level. Two-thirds of participants (66.7%) believed the current equipoise in transfusion targets warrants a randomized controlled trial (RCT), and 79.5% of these respondents indicated a willingness to enroll patients. CONCLUSIONS: This survey highlights the significant variability in the management of acute traumatic SCI, particularly regarding MAP, SCPP, and Hb transfusion thresholds among Canadian healthcare providers. The findings underscore the need for the development of evidence-based guidelines and the implementation of multicenter RCTs to establish best practices and optimize the care of this complex patient population.
