Prediction of Bladder Outcomes after Traumatic Spinal Cord Injury: A Longitudinal Cohort Study.
BACKGROUND
Neurogenic bladder dysfunction represents one of the most common and devastating sequelae of traumatic spinal cord injury (SCI). As early prediction of bladder outcomes is essential to counsel patients and to plan neurourological management, we aimed to develop and validate a model to predict urinary continence and complete bladder emptying 1 y after traumatic SCI.


RESULTS
Using multivariate logistic regression analysis from the data of 1,250 patients with traumatic SCI included in the European Multicenter Spinal Cord Injury study, we developed two prediction models of urinary continence and complete bladder emptying 1 y after traumatic SCI and performed an external validation in 111 patients. As predictors, we evaluated age, gender, and all variables of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and of the Spinal Cord Independence Measure (SCIM). Urinary continence and complete bladder emptying 1 y after SCI were assessed through item 6 of SCIM. The full model relies on lower extremity motor score (LEMS), light-touch sensation in the S3 dermatome of ISNCSI, and SCIM subscale respiration and sphincter management: the area under the receiver operating characteristics curve (aROC) was 0.936 (95% confidence interval [CI]: 0.922-0.951). The simplified model is based on LEMS only: the aROC was 0.912 (95% CI: 0.895-0.930). External validation of the full and simplified models confirmed the excellent predictive power: the aROCs were 0.965 (95% CI: 0.934-0.996) and 0.972 (95% CI 0.943-0.999), respectively. This study is limited by the substantial number of patients with a missing 1-y outcome and by differences between derivation and validation cohort.


CONCLUSIONS
Our study provides two simple and reliable models to predict urinary continence and complete bladder emptying 1 y after traumatic SCI. Early prediction of bladder function might optimize counselling and patient-tailored rehabilitative interventions and improve patient stratification in future clinical trials.
Neurology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.|Specialization School in Physical Medicine and Rehabilitation, Department of Clinical-Surgical Sciences, University of Pavia, Rehabilitation Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Chiara
C
Pavese
Neuro-Urology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.|Brain Research Institute, University of Zürich, Zürich, Switzerland.
Marc P
MP
Schneider
Neurology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
Martin
M
Schubert
Neurology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
Armin
A
Curt
Spinal Cord Unit, IRCCS Fondazione Santa Lucia, Rome, Italy.
Giorgio
G
Scivoletto
Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Unit for Functional Urology, Department of Urology, Policlinico Tor Vergata, Rome, Italy.
Enrico
E
Finazzi-Agrò
Neuro-Urology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
Ulrich
U
Mehnert
Spinal Cord Injury Center, BG-Trauma Center, Murnau, Germany.
Doris
http://orcid.org/0000-0002-3261-2381
D
Maier
Spinal Cord Injury Center, Hohe Warte, Bayreuth, Germany.
Rainer
R
Abel
Berufsgenossenschaftliche Kliniken Bergmannstrost, Zentrum für Rückenmarkverletzte und Klinik für Orthopädie, Halle, Germany.
Frank
F
Röhrich
Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany.
Norbert
N
Weidner
Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany.
Rüdiger
R
Rupp
Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
Alfons G
AG
Kessels
Medignition Inc., Research Consultants, Zürich, Switzerland.
Lucas M
LM
Bachmann
Neuro-Urology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
Thomas M
TM
Kessler
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D013119:Spinal Cord Injuries / Q000150:complications* / Q000453:epidemiology; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult