A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors.

Wilson, Jefferson R

Grossman, Robert G

Frankowski, Ralph F

Kiss, Alexander

Davis, Aileen M

Kulkarni, Abhaya V

Harrop, James S

Aarabi, Bizhan

Vaccaro, Alexander

Tator, Charles H

Dvorak, Marcel

Shaffrey, Christopher I

Harkema, Susan

Guest, James D

Fehlings, Michael G

2023-08-30T00:15:48Z

2023-08-30T00:15:48Z

2012-09

2023-08-30T00:15:48Z

To improve clinicians' ability to predict outcome after spinal cord injury (SCI) and to help classify patients within clinical trials, we have created a novel prediction model relating acute clinical and imaging information to functional outcome at 1 year. Data were obtained from two large prospective SCI datasets. Functional independence measure (FIM) motor score at 1 year follow-up was the primary outcome, and functional independence (score ≥ 6 for each FIM motor item) was the secondary outcome. A linear regression model was created with the primary outcome modeled relative to clinical and imaging predictors obtained within 3 days of injury. A logistic model was then created using the dichotomized secondary outcome and the same predictor variables. Model validation was performed using a bootstrap resampling procedure. Of 729 patients, 376 met the inclusion criteria. The mean FIM motor score at 1 year was 62.9 (±28.6). Better functional status was predicted by less severe initial American Spinal Injury Association (ASIA) Impairment Scale grade, and by an ASIA motor score >50 at admission. In contrast, older age and magnetic resonance imaging (MRI) signal characteristics consistent with spinal cord edema or hemorrhage predicted worse functional outcome. The linear model predicting FIM motor score demonstrated an R-square of 0.52 in the original dataset, and 0.52 (95% CI 0.52,0.53) across the 200 bootstraps. Functional independence was achieved by 148 patients (39.4%). For the logistic model, the area under the curve was 0.93 in the original dataset, and 0.92 (95% CI 0.92,0.93) across the bootstraps, indicating excellent predictive discrimination. These models will have important clinical impact to guide decision making and to counsel patients and families.

0897-7151

1557-9042

https://hdl.handle.net/10161/28859

eng

Mary Ann Liebert Inc

Journal of neurotrauma

10.1089/neu.2012.2417

Humans

Spinal Cord Injuries

Acute Disease

Disability Evaluation

Trauma Severity Indices

Registries

Linear Models

Follow-Up Studies

Prospective Studies

Predictive Value of Tests

Recovery of Function

Outcome and Process Assessment, Health Care

A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors.

Journal article

Shaffrey, Christopher I|0000-0001-9760-8386

2263

2271

13

Duke

School of Medicine

Clinical Science Departments

Orthopaedic Surgery

Neurosurgery

Published

29