Abstract Details

Title Are the Randomized Clinical Trial Data on Initial Management of Acute Traumatic Cervical Spinal Cord Injury Generalizable to Elderly Patients in Clinical Practice?

Topic Critical Care/Emergency Neurology/Trauma

Presentation(s) P01 - (-)

Poster/Presentation
Number 023

Objective

Background There has been a worldwide escalation in fall-related SCI among the elderly over the last 20 years. Relatively little has been reported regarding clinical and neurological outcomes in the elderly after acute traumatic SCI.

Design/Methods The literature search for this systematic review was conducted using MEDLINE, EMBASE and Cochrane databases. All RCTs focused on initial management of patients with acute traumatic SCI published from 1980 to 2011 were included. The age distribution in those captured studies was compared with the population in Canada, Ontario and Toronto based on data from the National Trauma Registry, Ontario Trauma Registry and Toronto Western Hospital Spinal Cord Database. Age distribution was collapsed into elderly individuals (65 years of age or older) and younger individuals.

Results This systematic review captured nine RCTs on treatment of patients with acute traumatic SCI that reported the subject's age distribution. These were the First, Second and Third NASCIS trials, Maryland GM-1 trial, Japanese trial, Nimodipine trial, Gacycline trial, Sygen GM-1 trial and Cethrin trial. The frequency of elderly SCI individuals in RCTs varied from zero to 8.8%, which were significantly different from the proportion of elderly SCI individuals in the population data (23.4% to 34%). Of note, three studies limited the inclusion of subjects based on their age at time of SCI.

Conclusions The results of this systematic review are indicative of an ageistic selection of patients for randomized clinical trials in the initial management of traumatic SCI. Given this, the generalizability of the data from these RCTs on management of acute traumatic SCI is limited. Investigators of future RCTs should consider the age distribution of potential subjects in the study inclusion and exclusion criteria.

Authors/Disclosures
Julio C. Furlan, MD, PhD, MBA, MSc, FAAN (Lyndhurst Centre, Toronto Rehabilitation Institute; University of Toronto) PRESENTER	The institution of Dr. Furlan has received research support from Wings for Life Spinal Cord Research Foundation. The institution of Dr. Furlan has received research support from Craig H Neilsen Foundation. The institution of Dr. Furlan has received research support from Ontario Neurotrauma Foundation. The institution of Dr. Furlan has received research support from Cervical Spine Research Society. The institution of Dr. Furlan has received research support from J P Bickell Foundation. The institution of Dr. Furlan has received research support from Praxis Spinal Cord Institute. The institution of Dr. Furlan has received research support from Cervical Spine Research Society. The institution of Dr. Furlan has received research support from CRANIA. The institution of Dr. Furlan has received research support from Craig H Neilsen Foundation. The institution of Dr. Furlan has received research support from Cervical Spine Research Society. The institution of Dr. Furlan has received research support from Cervical Spine Research Society. The institution of Dr. Furlan has received research support from Tanenbaum Institute for Science in Sport. .
Christopher Goetz, MD, FAAN (Rush University Medical Center)	The institution of Dr. Goetz has received research support from Michael J. Fox Foundation. The institution of Dr. Goetz has received research support from NIH. The institution of Dr. Goetz has received research support from Department of Defense. Dr. Goetz has received publishing royalties from a publication relating to health care. Dr. Goetz has received publishing royalties from a publication relating to health care. Dr. Goetz has received publishing royalties from a publication relating to health care.
	No disclosure on file
	No disclosure on file

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