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

Publication ,  Journal Article
Wilson, JR; Grossman, RG; Frankowski, RF; Kiss, A; Davis, AM; Kulkarni, AV; Harrop, JS; Aarabi, B; Vaccaro, A; Tator, CH; Dvorak, M; Guest, JD ...
Published in: J Neurotrauma
September 2012

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.

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Published In

J Neurotrauma

DOI

EISSN

1557-9042

Publication Date

September 2012

Volume

29

Issue

13

Start / End Page

2263 / 2271

Location

United States

Related Subject Headings

  • Trauma Severity Indices
  • Spinal Cord Injuries
  • Registries
  • Recovery of Function
  • Prospective Studies
  • Predictive Value of Tests
  • Outcome and Process Assessment, Health Care
  • Neurology & Neurosurgery
  • Linear Models
  • Humans
 

Citation

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Wilson, J. R., Grossman, R. G., Frankowski, R. F., Kiss, A., Davis, A. M., Kulkarni, A. V., … Fehlings, M. G. (2012). A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors. J Neurotrauma, 29(13), 2263–2271. https://doi.org/10.1089/neu.2012.2417
Wilson, Jefferson R., Robert G. Grossman, Ralph F. Frankowski, Alexander Kiss, Aileen M. Davis, Abhaya V. Kulkarni, James S. Harrop, et al. “A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors.J Neurotrauma 29, no. 13 (September 2012): 2263–71. https://doi.org/10.1089/neu.2012.2417.
Wilson JR, Grossman RG, Frankowski RF, Kiss A, Davis AM, Kulkarni AV, et al. A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors. J Neurotrauma. 2012 Sep;29(13):2263–71.
Wilson, Jefferson R., et al. “A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors.J Neurotrauma, vol. 29, no. 13, Sept. 2012, pp. 2263–71. Pubmed, doi:10.1089/neu.2012.2417.
Wilson JR, Grossman RG, Frankowski RF, Kiss A, Davis AM, Kulkarni AV, Harrop JS, Aarabi B, Vaccaro A, Tator CH, Dvorak M, Shaffrey CI, Harkema S, Guest JD, Fehlings MG. A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors. J Neurotrauma. 2012 Sep;29(13):2263–2271.
Journal cover image

Published In

J Neurotrauma

DOI

EISSN

1557-9042

Publication Date

September 2012

Volume

29

Issue

13

Start / End Page

2263 / 2271

Location

United States

Related Subject Headings

  • Trauma Severity Indices
  • Spinal Cord Injuries
  • Registries
  • Recovery of Function
  • Prospective Studies
  • Predictive Value of Tests
  • Outcome and Process Assessment, Health Care
  • Neurology & Neurosurgery
  • Linear Models
  • Humans