plexity of spinal cord injuries, only a limited number of guidelines have been developed or are under development. Clinical practice guidelines for spinal cord injuries have come largely from two professional groups, both of which rated the evidence by similar criteria to arrive at formal treatment recommendations. Guidelines from the American Association of Neurological Surgeons and the Congress of Neurological Surgeons (AANS/CNS) deal with acute care, and those developed by the Consortium for Spinal Cord Medicine deal with acute and chronic care (Table 4-1) (PVA, 2002). Other groups have developed additional evidence-based clinical guidelines (AHRQ, 1998). Panels accord the greatest weight to evidence from randomized, prospective, controlled clinical trials and the least weight to evidence from case reports describing one or more patients who improved with treatment. A lack of clinical guidelines for a particular treatment does

TABLE 4-1 Clinical Practice Guidelines for Treatment of Spinal Cord Injury

Current Guidelines

 

Acute Care

 

Acute management of autonomic dysreflexia: Individuals with spinal cord injury presenting to health care facilities (1997, 2001)a

 

Pressure ulcer prevention and treatment following spinal cord injury: A clinical practice guideline for health-care professionals (2000)a

 

Diagnosis of occipital condyle fractures by computed tomography (CT) imagingb

 

Isolated fractures of the axis in adultsb

 

Management of pediatric cervical spinal injuriesb

 

Chronic Care

 

Neurogenic bowel management in adults with spinal cord injury (1998)a

 

Depression following spinal cord injury: A clinical practice guideline for primary care physicians (1998)a

 

Outcomes following traumatic spinal cord injury: Clinical practice guidelines for health-care professionals (1999)a

 

Prevention of thromboembolism in spinal cord injury (1997a, 2002b)

Guidelines Under Development

 

Respiratory managementa

 

Preservation of the upper extremity functiona

 

Bladder managementa

 

Acute management of spinal cord injurya

 

Sexuality and reproductive healtha

 

Treatment of spasticitya

aConsortium for Spinal Cord Medicine.

bAmerican Association of Neurological Surgeons and the Congress of Neurological Surgeons.

SOURCES: Apuzzo, 2002; PVA, 1998, 2000, 2001, 2002.



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