A retrospective review of safety using a nursing driven protocol for autonomic dysreflexia in patients with spinal cord injuries

The Journal of Spinal Cord Medicine, 2016 · DOI: 10.1080/10790268.2015.1118186 · Published: January 1, 2016

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

Autonomic dysreflexia (AD) is a condition that causes episodes of high blood pressure in people with spinal cord injuries (SCI). It is triggered by stimuli below the injury level, leading to unregulated sympathetic discharges. This study reviews the safety and effectiveness of a nursing-driven protocol for treating AD, using conservative measures, nitroglycerin paste, and oral hydralazine. The protocol was found to be effective in achieving target blood pressure with a high success rate and a low incidence of adverse events, mainly hypotension that usually resolved on its own.

Study Duration

3.5 Years

Participants

78 male patients with SCI

Evidence Level

Retrospective chart review

Key Findings

1
The nursing-driven protocol achieved target blood pressure in 97.6% of all episodes when followed.
2
Adverse events, all due to hypotension, occurred in 5.2% of all episodes, with only 0.9% requiring interventions beyond clinical monitoring.
3
97.3% of patients' initial autonomic dysreflexia episodes resolved using the protocol without needing further escalation of care.

Research Summary

This retrospective study evaluated the safety and efficacy of a nursing-driven protocol for managing autonomic dysreflexia (AD) in spinal cord injury (SCI) patients. The protocol included conservative measures, nitroglycerin paste, and oral hydralazine. The results showed high adherence to the protocol (92%) and a high success rate in achieving target blood pressure (97.6%). Adverse events, primarily hypotension, were infrequent and generally self-limited. The study concludes that this nursing-driven protocol is a safe and effective approach for treating AD in SCI inpatients, suggesting its potential utility in various healthcare settings.

Practical Implications

Rapid Treatment Delivery

Nursing-driven protocols enable quicker treatment of AD, potentially reducing episode length, severity, and associated complications.

Physician Resource Optimization

Physicians can focus on complex cases not resolved by the protocol, optimizing their time.

Broadened Applicability

Standardized protocols can be applied in resource-limited settings such as skilled nursing facilities and rehabilitation units.

Study Limitations

1
Potential for nurses to inadvertently treat essential hypertension instead of AD.
2
Possibility of under-diagnosing underlying etiologies, potentially increasing recurrence.
3
The patient population was exclusively male veterans with relatively long duration of SCI.

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