Evidence map›Paper›PMID 38526931›Full record

ArticleGlobal spine journal2024

Interventions to Optimize Spinal Cord Perfusion in Patients With Acute Traumatic Spinal Cord Injury: An Updated Systematic Review.

Nathan Evaniew, Benjamin Davies, Farzin Farahbakhsh, Michael G Fehlings, Mario Ganau, Daniel Graves, James D Guest, Radha Korupolu, Allan R Martin, Stephen L McKenna and 5 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Global spine journal, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 2 pooled it
13.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 31 citations in OpenAlex.

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  14. Critical Care of Spinal Cord Injury.Current neurology and neuroscience reports · 2024
    Review
  15. Article
  16. Article
  17. Recent trends in spinal trauma management and research.Journal of clinical orthopaedics and trauma · 2024
    Article
  18. Article
  19. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 13 institutions in 4 countries.

Nathan EvaniewMcCaig Institute for Bone and Joint Health, Department of Surgery, Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.ORCID 0000-0003-1974-5224
Benjamin DaviesDepartment of Neurosurgery, Cambridge University, Cambridge, UK.ORCID 0000-0003-0591-5069
Farzin FarahbakhshDepartment of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.ORCID 0000-0003-4435-9034
Michael G FehlingsDivision of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada.ORCID 0000-0002-5722-6364
Mario GanauNuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Daniel GravesCollege of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA USA.
James D GuestDepartment of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA.
Radha KorupoluDepartment of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, TX, USA.
Allan R MartinDepartment of Neurological Surgery, University of California, Davis, CA, USA.
Stephen L McKennaDepartment of Neurosurgery, Stanford University, Stanford, CA, USA.ORCID 0000-0003-2030-8988
Lindsay A TetreaultDepartment of Neurology, NYU Langone Medical Center, New York, NY, USA.
Aditya VedantamDepartment of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Erika D BrodtAggregate Analytics, Inc, Fircrest, WA, USA.
Andrea C SkellyAggregate Analytics, Inc, Fircrest, WA, USA.
Brian K KwonDepartment of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.
Medical College of Wisconsin · USNeurological Surgery · USNYU Langone Health · USShariati Hospital · IRStanford University · USThe University of Texas Health Science Center at Houston · USThomas Jefferson University · USUniversity Health Network · CAUniversity of British Columbia · CAUniversity of Calgary · CAUniversity of Cambridge · GBUniversity of Miami · USUniversity of Oxford · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

STUDY

designSystematic review update.

objectivesInterventions that aim to optimize spinal cord perfusion are thought to play an important role in minimizing secondary ischemic damage and improving outcomes in patients with acute traumatic spinal cord injuries (SCIs). However, exactly how to optimize spinal cord perfusion and enhance neurologic recovery remains controversial. We performed an update of a recent systematic review (Evaniew et al, J. Neurotrauma 2020) to evaluate the effects of Mean Arterial Pressure (MAP) support or Spinal Cord Perfusion Pressure (SCPP) support on neurological recovery and rates of adverse events among patients with acute traumatic SCI.

methodsWe searched PubMed/MEDLINE, EMBASE and ClinicalTrials.gov for new published reports. Two reviewers independently screened articles, extracted data, and evaluated risk of bias. We implemented the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach to rate confidence in the quality of the evidence.

resultsFrom 569 potentially relevant new citations since 2019, we identified 9 new studies for inclusion, which were combined with 19 studies from a prior review to give a total of 28 studies. According to low or very low quality evidence, the effect of MAP support on neurological recovery is uncertain, and increased SCPP may be associated with improved neurological recovery. Both approaches may involve risks for specific adverse events, but the importance of these adverse events to patients remains unclear. Very low quality evidence failed to yield reliable guidance about particular monitoring techniques, perfusion ranges, pharmacological agents, or durations of treatment.

conclusionsThis update provides an evidence base to support the development of a new clinical practice guideline for the hemodynamic management of patients with acute traumatic SCI. While avoidance of hypotension and maintenance of spinal cord perfusion are important principles in the management of an acute SCI, the literature does not provide high quality evidence in support of a particular protocol. Further prospective, controlled research studies with objective validated outcome assessments are required to examine interventions to optimize spinal cord perfusion in this setting.

Indexed as

cervicalspinal cord injurytrauma

Identifiers

PMID38526931
PMCPMC10964891
OpenAlexW4393165897

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.