Steroid Use for Acute Spinal Cord Injury in Latin America: A Potentially Dangerous Practice Guided by Fear of Lawsuit.

BACKGROUND: Current international guidelines do not recommend the routine administration of methylprednisolone (MP) in patients with acute spinal cord injury (SCI). Its use is known to be associated with complications and death.

OBJECTIVES: To identify patterns of practice and reasons for MP prescription for acute SCI in Latin America.

METHODS: Portuguese- and Spanish-modified versions of a previously published questionnaire were used to evaluate opinions about the administration of MP for acute SCI in Latin America. This Internet-based survey was conducted with members of AOSpine Latin America.

RESULTS: A total of 970 AOSpine Latin America members from 20 countries answered the electronic questionnaire. Of the total sample, 834 surgeons (86%) reported that they routinely treat patients with acute SCI, and 56.1% of them reported routine administration of MP for these patients. Use of MP was associated with country, specialty, length of clinical practice, and number of SCI treated yearly. Among the 468 surgeons who report routine administration of MP, 56.1% believe in the clinical benefit, 29.3% do this because of fear of litigation, 27.1% because this is a protocol in their hospital, 3.5% because they believe that MP has no major adverse effects.

CONCLUSIONS: Despite increasing evidence against the routine administration of MP in patients with SCI and international guidelines that do not recommend its use, this potentially dangerous practice remains common on this continent. The Latin American medical associations need to produce guidelines to standardize practices with acute SCI. Moreover, educational campaigns might reduce practices guided mainly by misperception of legal issues instead of clinical benefit.