A Scoping Review of Clinical Practice Guidelines for the Acute Care of Patients with Spinal Cord Injury: Respiratory, Hemodynamic and Neuroprotective Management
Bibliographic record
Abstract
Background: Given the complex nature of acute SCI management, there is a pressing need to review and evaluate existing clinical practice guidelines (CPGs). This study aims to evaluate CPGs and create a summary of recommendations related to the in-hospital acute management of SCI in three different areas: respiratory management, hemodynamic management and the use of neuroprotective agents. Method: This study was conducted in accordance with the guidelines set by the Joanna Briggs Institute, and PRISMA-ScR. A search was conducted in thirteen databases and the gray literature. Screening and data extraction was completed by two independent reviewers against pre-specified eligibility criteria. The AGREE II tool was used to appraise the quality of the CPGs. Results: The search identified 12 eligible studies. Seven (n=7) studies were published in the last five years. Overall, the recommendations were supported by low quality evidence. Based on the AGREE II quality appraisal, seven out of twelve CPGs can be recommended for use, and one can be recommended with modification. The following domains scored the highest average score: “Clarity of Presentation,” “Scope and Purpose,” and “Editorial Independence.” Domain 5 “Applicability” and domain 2 “Stakeholder Involvement” scored the lowest average score. While the majority of the recommendations were consistent, there were contradicting recommendations concerning the use of methylprednisolone. Conclusion: The CPGs in the management of acute SCI are overall based on low-quality evidence. More evidence is needed to recommend for or against the use of methylprednisolone in acute SCI patients. Indeed, there is a need for the development of rigorous and up-to-date CPGs that is based on high-quality evidence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.116 | 0.370 |
| Meta-epidemiology (narrow) | 0.003 | 0.003 |
| Meta-epidemiology (broad) | 0.007 | 0.010 |
| Bibliometrics | 0.047 | 0.037 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.007 | 0.009 |
| Open science | 0.006 | 0.006 |
| Research integrity | 0.007 | 0.005 |
| Insufficient payload (model declined to judge) | 0.007 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".