Derivation and Validation of a Clinical Prediction Rule for Upper Limb Functional Outcomes After Traumatic Cervical Spinal Cord Injury

医学 脊髓损伤 四肢瘫痪 物理医学与康复 物理疗法 逻辑回归 回顾性队列研究 功能独立性测度 队列 损伤严重程度评分 康复 脊髓 外科 毒物控制 伤害预防 内科学 急诊医学 精神科
作者
Saad Javeed,Jacob K. Greenberg,Justin K. Zhang,Christopher F. Dibble,Jawad M. Khalifeh,Ying Liu,Thomas J. Wilson,Lynda J.‐S. Yang,Yikyung Park,Wilson Z. Ray
出处
期刊:JAMA network open [American Medical Association]
卷期号:5 (12): e2247949-e2247949 被引量:10
标识
DOI:10.1001/jamanetworkopen.2022.47949
摘要

Importance Traumatic cervical spinal cord injury (SCI) can result in debilitating paralysis. Following cervical SCI, accurate early prediction of upper limb recovery can serve an important role in guiding the appropriateness and timing of reconstructive therapies. Objective To develop a clinical prediction rule to prognosticate upper limb functional recovery after cervical SCI. Design, Setting, and Participants This prognostic study was a retrospective review of a longitudinal cohort study including patients enrolled in the National SCI model systems (SCIMS) database in US. Eligible patients were 15 years or older with tetraplegia (neurological level of injury C1-C8, American Spinal Cord Injury Association [ASIA] impairment scale [AIS] A-D), with early (within 1 month of SCI) and late (1-year follow-up) clinical examinations from 2011 to 2016. The data analysis was conducted from September 2021 to June 2022. Main Outcomes and Measures The primary outcome was a composite of dependency in eating, bladder management, transfers, and locomotion domains of functional independence measure at 1-year follow-up. Each domain ranges from 1 to 7 with a lower score indicating greater functional dependence. Composite dependency was defined as a score of 4 or higher in at least 3 chosen domains. Multivariable logistic regression was used to predict the outcome based on early neurological variables. Discrimination was quantified using C statistics, and model performance was internally validated with bootstrapping and 10-fold cross-validation. The performance of the prediction score was compared with AIS grading. Data were split into derivation (2011-2014) and temporal-validation (2015-2016) cohorts. Results Among 2373 patients with traumatic cervical SCI, 940 had complete 1-year outcome data (237 patients [25%] aged 60 years or older; 753 men [80%]). The primary outcome was present in 118 patients (13%), which included 92 men (78%), 83 (70%) patients who were younger than 60 years, and 73 (62%) patients experiencing AIS grade A SCI. The variables significantly associated with the outcome were age (age 60 years or older: OR, 2.31; 95% CI, 1.26-4.19), sex (men: OR, 0.60; 95% CI, 0.31-1.17), light-touch sensation at C5 (OR, 0.44; 95% CI, 0.44-1.01) and C8 (OR, 036; 95% CI, 0.24-0.53) dermatomes, and motor scores of the elbow flexors (C5) (OR, 0.74; 95% CI, 0.60-0.89) and wrist extensors (C6) (OR, 0.61; 95% CI, 0.49-0.75). A multivariable model including these variables had excellent discrimination in distinguishing dependent from independent patients in the temporal-validation cohort ( C statistic, 0.90; 95% CI, 0.88-0.93). A clinical prediction score (range, 0 to 45 points) was developed based on these measures, with higher scores increasing the probability of dependency. The discrimination of the prediction score was significantly higher than from AIS grading (change in AUC, 0.14; 95% CI, 0.10-0.18; P < .001). Conclusions and Relevance The findings of this study suggest that this prediction rule may help prognosticate upper limb function following cervical SCI. 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.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
wy完成签到,获得积分10
刚刚
无花果应助Judy采纳,获得30
1秒前
香蕉觅云应助hehexi采纳,获得10
1秒前
慕青应助Dr.c采纳,获得10
1秒前
2秒前
2秒前
发嗲的黑夜完成签到,获得积分10
2秒前
hlxhlx发布了新的文献求助10
2秒前
2秒前
可靠的南露应助不厌采纳,获得30
4秒前
我想@科研发布了新的文献求助10
4秒前
Raymond发布了新的文献求助10
5秒前
mlml完成签到,获得积分10
5秒前
5秒前
Erislastem发布了新的文献求助10
6秒前
小王同学完成签到,获得积分10
6秒前
7秒前
qwt_hello完成签到,获得积分10
7秒前
7秒前
arsenal发布了新的文献求助10
7秒前
8秒前
斯文月亮发布了新的文献求助10
8秒前
李健的粉丝团团长应助lin采纳,获得10
8秒前
AA完成签到,获得积分20
8秒前
传奇3应助宫野珏采纳,获得10
9秒前
牛马发布了新的文献求助10
9秒前
9秒前
博弈春秋完成签到,获得积分10
9秒前
9秒前
9秒前
11发布了新的文献求助10
10秒前
Lucas应助夜无疆采纳,获得10
10秒前
打打应助syh采纳,获得30
10秒前
11秒前
OLDBLOW发布了新的文献求助10
11秒前
chwjx完成签到,获得积分10
11秒前
11完成签到,获得积分10
11秒前
华仔应助hlxhlx采纳,获得10
11秒前
13秒前
13秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
Picture Books with Same-sex Parented Families: Unintentional Censorship 500
Nucleophilic substitution in azasydnone-modified dinitroanisoles 500
不知道标题是什么 500
A Preliminary Study on Correlation Between Independent Components of Facial Thermal Images and Subjective Assessment of Chronic Stress 500
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 360
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3970949
求助须知:如何正确求助?哪些是违规求助? 3515634
关于积分的说明 11179061
捐赠科研通 3250769
什么是DOI,文献DOI怎么找? 1795474
邀请新用户注册赠送积分活动 875831
科研通“疑难数据库(出版商)”最低求助积分说明 805188