Study DesignSurvey based study.ObjectivesTo evaluate current patterns for managing SCI among spine surgeons in North America.MethodsA survey of the North American Clinical Trials Network (NACTN) and other institutions collected institutional demographics and specific practices on acute SCI management. Variables included trauma level designation, annual case volumes (patient number, spine fracture and surgery performed), steroid usage, emergent cervical traction, magnetic resonance imaging (MRI) access, surgical decompression timing, intraoperative ultrasound and neuromonitoring use, mean arterial pressure (MAP) and spinal cord perfusion pressure (SCPP) targets, lumbar drain use, and the influence of American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade on decision-making.ResultsThirty surgeons from 23 institutions responded (93.3% Level 1 trauma centers). Most centers (93.3%) had immediate MRI access; about 70% of physicians did not use steroids. Emergent cervical traction was used by 60%. An aim of surgical decompression within 24 h was reported by 90%, with 20% operating immediately upon arrival. MAP goals were used by 93.3%, most targeting 85-90 mmHg for ≥5 days. Lumbar drains for SCPP optimization were used in 30%, typically targeting intrathecal pressure (ITP) < 15 mmHg and SCPP >60 mmHg. Management varied by AIS grade in 43.4%.ConclusionDespite agreement in the general scope of acute SCI care, significant implementation heterogeneity exists across North American spine centers. Variability was pronounced in steroid use, timing of decompression (90% within 24 h), cervical traction, and lumbar drain utilization. These findings call for evidence-based protocols to guide acute SCI management and reduce inter-institutional practice variation.

INTRODUCTION: Post-traumatic seizures (PTS) are a major source of disability after traumatic brain injury (TBI). The Brain Trauma Foundation Guidelines recommend prophylactic anti-epileptics (AEDs) for early PTS in severe TBI, but high-quality evidence is lacking in mild or moderate TBI. METHODS: We performed a prospective, multicenter study evaluating consecutive patients who presented to a level 1 trauma center from January 2017 through December 2020. Patients were excluded for previous seizure history, current AED use, or a neurosurgical procedure. Patients were given a 7-day course of prophylactic AEDs on a week-by-week basis and followed with in-person clinic visits, in-hospital evaluation, or a validated phone questionnaire. RESULTS: 490 patients were enrolled, 349 (71.2%) had follow-up, and 139 (39.8%) were given prophylactic AEDs. There was no difference between seizure rates for the prophylactic AED group (0.7%) and those without (2.9%; p = 0.25). Patients who had a PTS were on average older (81.4 years) than patients without a seizure (64.8 years; p = 0.02). Seizure rate increased linearly by age groups: <60 years-old (0%); 60-70 years-old (1.7%); 70-80 years-old (2.3%); and >80 years-old (4.6%). CONCLUSION: Prophylactic AEDs did not provide a benefit for PTS reduction in mild TBI patients with a positive CT head scan. Future studies should be appropriately powered for the small effect size of AEDs in mild TBI and evaluate the effects between age and prophylactic AED use.

Background: Posttraumatic seizures (PTSs) are a major source of disability after traumatic brain injury (TBI). The Brain Trauma Foundation Guidelines recommend prophylactic anti-epileptics (AEDs) for early PTS in severe TBI, but high-quality evidence is lacking in mild TBI. Methods: To determine the benefit of administering prophylactic AEDs, we performed a prospective and multicenter study evaluating consecutive patients who presented to a Level 1 trauma center from January 2017 to December 2020. We included all patients with mild TBI defined as Glasgow Coma Scale (GCS) 13–15 and a positive head computed tomography (CT). Patients were excluded for previous seizure history, current AED use, or a neurosurgical procedure. Patients were given a prophylactic 7-day course of AEDs on a week-on versus week-off basis and followed with in-person clinic visits, in-hospital evaluation, or a validated phone questionnaire. Results: Four hundred and ninety patients were enrolled, 349 (71.2%) had follow-up, and 139 (39.8%) were given prophylactic AEDs. There was no difference between seizure rates for the prophylactic AED group (0.7%) and those without (2.9%; P = 0.25). Patients who had a PTS were on average older (81.4 years) than patients without a seizure (64.8 years; P = 0.02). Seizure rate increased linearly by age groups: <60 years old (0%); 60–70 years old (1.7%); 70–80 years old (2.3%); and >80 years old (4.6%). Conclusion: Prophylactic AEDs did not provide a benefit for PTS reduction in mild TBI patients with a positive CT head scan.