Prediction rule may identify upper limb functional recovery after spinal cord injury
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Published results showed use of a prediction rule may help identify patients with upper limb functional recovery after traumatic cervical spinal cord injury.
“This tool can be used to set patient expectations, rehabilitation goals and aid decision-making regarding the appropriateness and timing for upper limb reconstructive surgeries,” the authors wrote.
In a retrospective review of a longitudinal cohort study that included patients enrolled in the National Spinal Cord Injury model systems database, researchers included patients aged 15 years or older with tetraplegia who had clinical examinations within 1 month of spinal cord injury and at 1-year follow-up from 2011 to 2016. Researchers considered the primary outcome as a composite of dependency in eating, bladder management, transfers and locomotion domains of functional independence measure at 1-year follow-up.
Researchers used multivariable logistic regression to predict the outcome based on early neurological variables, quantified discrimination using C statistics and internally validated model performance with bootstrapping and 10-fold cross-validation. Researchers compared the performance of the prediction score with American Spinal Injury Association Impairment Scale (AIS) grading. Researchers split data into derivation and temporal-validation cohorts.
Among 2,373 patients with traumatic cervical spinal cord injuries, results showed 940 patients completed 1-year outcome data. The primary outcome was present in 13% of patients, which included 78% men, 70% of patients who were younger than 60 years of age and 62% of patients experiencing AIS grade A spinal cord injury. Researchers found age, sex, light-tough sensation at C5 and C8 dermatomes, and motor scores of the elbow flexors and wrist extensors had a significant association with the outcome. When included in a multivariable model, these variables had excellent discrimination in distinguishing dependent from independent patients in the temporal-validation cohort. Researchers developed a clinical prediction score based on these measures, with higher scores increasing the probability of dependency. Results showed the prediction score had significantly higher discrimination than AIS grading.
“With early prediction of upper limb function, our results could inform clinical practice guidelines to provide stronger recommendations supporting the role of reconstructive surgery following cervical [spinal cord injury] SCI,” the authors wrote. “Additionally, this prediction tool may be used to identify dependent tetraplegic patients for early enrollment in acute interventional clinical trials.”
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