Abstract：
Complications such as pressure sores, pulmonary infection, urinary tract infection (UTI), and venous thromboembolism (VTE) are common after spinal cord injury (SCI). These have serious consequences for patients\' physical, social, and vocational well-being. Several authoritative organizations have developed guidelines for managing these complications after SCI.
We aim to systematically review and appraise guidelines on the management of four common complications (pressure sores, pulmonary infection, UTI, and VTE) after SCI as well as to summarize relevant recommendations and assess the quality of their supporting evidence.
Systematic review.
We searched Medline, Embase, Cochrane, and Web of Science, as well as guideline-specific databases (eg, National Guideline Clearinghouse) and Google Scholar, from January 2000 to January 2022. We included the most updated guidelines developed by specific authoritative organizations. We evaluated the included guidelines using the Appraisal of Guidelines for Research and Evaluation 2nd edition instrument, which measures six domains (eg, applicability). Recommendations extracted from guidelines were categorized as for, against, or neither for nor against. An evidence assessment was adopted to classify the quality of supporting evidence as poor, fair, or good.
Eleven guidelines from 2005 to 2020 were included, all of which, among the six domains, scored lowest in the domain of applicability. For pressure sores, guidelines recommended for skin inspection, repositioning, and the use of pressure reduction equipment as preventive measures and dressings, debridement, and surgery as treatment measures. For pulmonary infection, guidelines recommended for physical (eg, the use of an insufflation-exsufflation device) and pharmacological measures (eg, the use of bronchodilators). For UTI, guidelines recommended for antibiotics as a treatment measure but recommended against cranberries, methenamine salts, and acidification or alkalinization agents as preventive measures. For VTE prophylaxis, five guidelines recommended for low molecular weight heparin (LMWH). Three guidelines recommended against unfractionated heparin, whereas one guideline recommended for it. Most of the supporting evidence was of poor quality (130/139), and the rest was of fair quality (9/139).
For pressure sores, pulmonary infection, and UTI, evidence of poor to fair quality indicated consistent recommendations for prevention and treatment measures. For VTE, LMWH was consistently recommended, whereas recommendations on the use of unfractionated heparin were controversial.
We aim to systematically review and appraise guidelines on the management of four common complications (pressure sores, pulmonary infection, UTI, and VTE) after SCI as well as to summarize relevant recommendations and assess the quality of their supporting evidence.
Systematic review.
We searched Medline, Embase, Cochrane, and Web of Science, as well as guideline-specific databases (eg, National Guideline Clearinghouse) and Google Scholar, from January 2000 to January 2022. We included the most updated guidelines developed by specific authoritative organizations. We evaluated the included guidelines using the Appraisal of Guidelines for Research and Evaluation 2nd edition instrument, which measures six domains (eg, applicability). Recommendations extracted from guidelines were categorized as for, against, or neither for nor against. An evidence assessment was adopted to classify the quality of supporting evidence as poor, fair, or good.
Eleven guidelines from 2005 to 2020 were included, all of which, among the six domains, scored lowest in the domain of applicability. For pressure sores, guidelines recommended for skin inspection, repositioning, and the use of pressure reduction equipment as preventive measures and dressings, debridement, and surgery as treatment measures. For pulmonary infection, guidelines recommended for physical (eg, the use of an insufflation-exsufflation device) and pharmacological measures (eg, the use of bronchodilators). For UTI, guidelines recommended for antibiotics as a treatment measure but recommended against cranberries, methenamine salts, and acidification or alkalinization agents as preventive measures. For VTE prophylaxis, five guidelines recommended for low molecular weight heparin (LMWH). Three guidelines recommended against unfractionated heparin, whereas one guideline recommended for it. Most of the supporting evidence was of poor quality (130/139), and the rest was of fair quality (9/139).
For pressure sores, pulmonary infection, and UTI, evidence of poor to fair quality indicated consistent recommendations for prevention and treatment measures. For VTE, LMWH was consistently recommended, whereas recommendations on the use of unfractionated heparin were controversial.
摘要：
背景：压疮等并发症，肺部感染,尿路感染（UTI），脊髓损伤（SCI）后常见静脉血栓栓塞（VTE）。这些对患者的身体有严重的后果，社会,和职业福祉。一些权威组织已经制定了治疗SCI后这些并发症的指南。
目的：我们旨在系统回顾和评价有关四种常见并发症（压疮，肺部感染,UTI,和VTE）在SCI之后，以及总结相关建议并评估其支持证据的质量。
方法：系统评价。
方法：我们搜索了Medline，Embase,科克伦,和WebofScience,以及特定于指南的数据库(例如，国家准则信息交换所)和谷歌学者，从2000年1月到2022年1月。我们纳入了由特定权威机构制定的最新指南。我们使用《评估指南》第二版工具对纳入的指南进行了评估，测量六个域(例如，适用性)。从指南中提取的建议被分类为，反对,或者既不赞成也不反对。采取了证据评估，将支持证据的质量划分为较差，公平,或者很好。
结果：包括2005年至2020年的11条指南，所有这些,在六个领域中，在适用性领域得分最低。对于压疮，推荐的皮肤检查指南，重新定位,以及使用减压设备作为预防措施和敷料，清创术,和手术作为治疗措施。对于肺部感染，建议用于物理的准则(例如，使用吹气-排气装置)和药理学措施(例如，使用支气管扩张剂)。对于UTI,指南建议抗生素作为治疗措施，但建议反对小红莓，次甲基胺盐，和酸化或碱化剂作为预防措施。对于VTE预防，推荐低分子量肝素(LMWH)的五个指南。针对普通肝素推荐了三个指南，而一个准则建议它。大多数支持证据质量差(130/139)，其余的质量相当(9/139)。
结论：对于压疮，肺部感染,和UTI,质量差到一般的证据表明,对预防和治疗措施的建议是一致的.对于VTE，LMWH一直被推荐，而关于使用普通肝素的建议存在争议。
目的：我们旨在系统回顾和评价有关四种常见并发症（压疮，肺部感染,UTI,和VTE）在SCI之后，以及总结相关建议并评估其支持证据的质量。
方法：系统评价。
方法：我们搜索了Medline，Embase,科克伦,和WebofScience,以及特定于指南的数据库(例如，国家准则信息交换所)和谷歌学者，从2000年1月到2022年1月。我们纳入了由特定权威机构制定的最新指南。我们使用《评估指南》第二版工具对纳入的指南进行了评估，测量六个域(例如，适用性)。从指南中提取的建议被分类为，反对,或者既不赞成也不反对。采取了证据评估，将支持证据的质量划分为较差，公平,或者很好。
结果：包括2005年至2020年的11条指南，所有这些,在六个领域中，在适用性领域得分最低。对于压疮，推荐的皮肤检查指南，重新定位,以及使用减压设备作为预防措施和敷料，清创术,和手术作为治疗措施。对于肺部感染，建议用于物理的准则(例如，使用吹气-排气装置)和药理学措施(例如，使用支气管扩张剂)。对于UTI,指南建议抗生素作为治疗措施，但建议反对小红莓，次甲基胺盐，和酸化或碱化剂作为预防措施。对于VTE预防，推荐低分子量肝素(LMWH)的五个指南。针对普通肝素推荐了三个指南，而一个准则建议它。大多数支持证据质量差(130/139)，其余的质量相当(9/139)。
结论：对于压疮，肺部感染,和UTI,质量差到一般的证据表明,对预防和治疗措施的建议是一致的.对于VTE，LMWH一直被推荐，而关于使用普通肝素的建议存在争议。
