Jaycee R. Farmer

Study Design Retrospective cohort study. Objectives The primary objective was to examine changes in gabapentinoid prescribing among individuals with acute spinal cord injury. The secondary objective was to examine the effects of gabapentinoid prescriptions on neurological recovery. Setting Intensive Care Unit, Vancouver General Hospital, British Columbia, Canada. Methods Individuals admitted between 2010 and 2019 with cervical spinal cord injuries were identified from the Rick Hansen Spinal Cord Injury Registry (RHSCIR). The primary outcome was first gabapentinoid prescription following injury, and exposure was year of injury. The secondary outcome was recovery in sensorimotor function, measured by changes in American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades between admission and discharge. We analyzed associations between gabapentinoid prescriptions and year of injury using Cox regression, and neurological recovery using multivariable logistic regression. Results Of 257 individuals with cervical spinal cord injury, 79% (n = 204) were prescribed a gabapentinoid within 30 days of injury. Rates of gabapentinoid prescription in the 30 days following injury increased from 41% in 2010/2011 to 93% in 2018/2019. In a subgroup analysis of individuals with incomplete injuries, early (i.e., hyperacute; <5 days post-injury) gabapentinoid use was significantly associated with greater neurological recovery (adjusted OR = 2.9, 95% CI, 1.1 to 7.9). Conclusions Gabapentinoid prescribing in acute spinal cord injury shifted markedly between 2010 and 2019, and was associated with improved neurological recovery in individuals with incomplete injuries. Further study is warranted to assess prescribing practices at other acute care hospitals and to characterize long-term safety.