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

Jefferson R. Wilson, Robert G. Grossman, Ralph F. Frankowski, Alexander Kiss, Aileen M. Davis, Abhaya V. Kulkarni, James S. Harrop, Bizhan Aarabi, Alexander Vaccaro, Charles H. Tator, Marcel Dvorak, Christopher I. Shaffrey, Susan Harkema, James D Guest, Michael G. Fehlings

Research output: Contribution to journalArticle

77 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)2263-2271
Number of pages9
JournalJournal of Neurotrauma
Volume29
Issue number13
DOIs
StatePublished - Sep 1 2012

Fingerprint

Spinal Cord Injuries
Linear Models
Logistic Models
Spinal Injuries
Area Under Curve
Edema
Spinal Cord
Decision Making
Magnetic Resonance Imaging
Clinical Trials
Hemorrhage
Wounds and Injuries
Datasets

Keywords

  • clinical prediction model
  • functional outcome
  • spinal cord injury

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

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. Journal of Neurotrauma, 29(13), 2263-2271. https://doi.org/10.1089/neu.2012.2417

A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors. / Wilson, Jefferson R.; Grossman, Robert G.; Frankowski, Ralph F.; Kiss, Alexander; Davis, Aileen M.; Kulkarni, Abhaya V.; Harrop, James S.; Aarabi, Bizhan; Vaccaro, Alexander; Tator, Charles H.; Dvorak, Marcel; Shaffrey, Christopher I.; Harkema, Susan; Guest, James D; Fehlings, Michael G.

In: Journal of Neurotrauma, Vol. 29, No. 13, 01.09.2012, p. 2263-2271.

Research output: Contribution to journalArticle

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 2012, 'A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors', Journal of Neurotrauma, vol. 29, no. 13, pp. 2263-2271. https://doi.org/10.1089/neu.2012.2417
Wilson, Jefferson R. ; Grossman, Robert G. ; Frankowski, Ralph F. ; Kiss, Alexander ; Davis, Aileen M. ; Kulkarni, Abhaya V. ; Harrop, James S. ; Aarabi, Bizhan ; Vaccaro, Alexander ; Tator, Charles H. ; Dvorak, Marcel ; Shaffrey, Christopher I. ; Harkema, Susan ; Guest, James D ; Fehlings, Michael G. / A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors. In: Journal of Neurotrauma. 2012 ; Vol. 29, No. 13. pp. 2263-2271.
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