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Summary

The incidence of neurogenic shock ranges from 7% to 45% in acute SCI patients (based on one RCT and four observational studies; Tuli et al. 2007; Mallek et al. 2012; Nakao et al. 2012; Bilello et al. 2003; Zipnick et al. 1993).

The incidence of neurogenic shock is higher in patients with AIS A and B injuries compared to AIS C and D injuries (based on one RCT; Tuli et al. 2007).

The incidence of neurogenic shock ranges from 19% to 29% in patients with a cervical SCI and from 5.5% to 7% in patients with a thoracic SCI (based on three observational studies; Mallek et al. 2012; Guly et al. 2008; Bilello et al. 2003).

The incidence of orthostatic hypotension ranges from 60% to 74% in acute SCI patients, and is more common in higher versus lower injuries and patients with tetraplegia versus paraplegia (based on two observational studies; Sidorov et al. 2008; Illman et al. 2000).

Patients with a cervical SCI are susceptible to developing early autonomic dysreflexia (based on one observational study; Krassioukov et al. 2003).

There is level 4 evidence (from one case series study; Wood et al. 2014) that pseudoephedrine may be an effective adjuvant for the treatment of neurogenic shock in acute SCI patients; however, this pharmacological agent may require up to one month for effectiveness.

There is level 4 evidence (from two case series; Moerman et al. 2011; Franga et al. 2006) that cardiac pacemaker implantation reduces bradycardic events in acute SCI patients.

There is level 3 evidence (from one case control; Evans et al. 2014) that enteral albuterol reduces bradycardic episodes in acute SCI patients.

There is level 4 evidence (from two pre-post studies; Vale et al. 1997; Levi et al. 1993) that aggressive hemodynamic support in acute SCI patients may lead to improved neurological function.

There is level 2 evidence (from three RCTs; Tesini et al. 2013; Elokda et al. 2000; Sampson et al. 2000) that functional electrical stimulation leads to improvement of symptoms of orthostatic hypotension in acute SCI patients.

There is level 2 evidence (from one RCT cross-over; Phillips et al. 2014) that midodrine hydrochloride leads to improved orthostatic tolerance in acute SCI patients.