Table 5.

Rating of overall strength of evidence

Question	Strength of evidence	Conclusion	Quality	Quantity	Consistency
Are there differences in recovery prognosis between complete SCI and other patterns of SCI in CGSWSCI?	Very low	Initial complete deficit results in poor outcome regardless of intervention	No	Yes	No
Does the use of steroids improve neurological recovery?	Low	Steroid administration causes no additional benefit to neurological outcomes	No	Yes	Yes
Does surgery affect neurological recovery in CGSWSCI?	Low	Surgery for bullet removal does not improve outcomes except for lower lumbosacral cauda equine injuries	No	Yes	Yes
	Very low	No significant difference is present between operative and nonoperative management CGSWSCI?	No	Yes	No
Does surgery result in an increased risk of complications of treatment?	Low	Common complications include neurogenic bladder, urinary tract infection, and chronic pain	No	Yes	Yes
	Very low	Surgery results in increased postoperative complications	No	Yes	No

SCI = spinal cord injury; CGSWSCI = civilian gunshot-induced spinal cord injury.