A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors.
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.
Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada.
Jefferson R
JR
Wilson
Robert G
RG
Grossman
Ralph F
RF
Frankowski
Alexander
A
Kiss
Aileen M
AM
Davis
Abhaya V
AV
Kulkarni
James S
JS
Harrop
Bizhan
B
Aarabi
Alexander
A
Vaccaro
Charles H
CH
Tator
Marcel
M
Dvorak
Christopher I
CI
Shaffrey
Susan
S
Harkema
James D
JD
Guest
Michael G
MG
Fehlings
D000208:Acute Disease; D004185:Disability Evaluation; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D010043:Outcome and Process Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D012042:Registries; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000401:mortality / Q000534:rehabilitation*; D015599:Trauma Severity Indices