A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study
Summary Background Traumatic spinal cord injury is a serious disorder in which early prediction of ambulation is important to counsel patients and to plan rehabilitation. We developed a reliable, validated prediction rule to assess a patient's chances of walking independently after such injury....
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| Veröffentlicht in: | The Lancet (British edition) 2011-03, Vol.377 (9770), p.1004-1010 |
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| creator | van Middendorp, Joost J, Dr Hosman, Allard JF, MD Donders, A Rogier T, PhD Pouw, Martin H, MD Ditunno, John F, Prof Curt, Armin, Prof Geurts, Alexander CH, Prof Van de Meent, Hendrik, MD |
| description | Summary Background Traumatic spinal cord injury is a serious disorder in which early prediction of ambulation is important to counsel patients and to plan rehabilitation. We developed a reliable, validated prediction rule to assess a patient's chances of walking independently after such injury. Methods We undertook a longitudinal cohort study of adult patients with traumatic spinal cord injury, with early (within the first 15 days after injury) and late (1-year follow-up) clinical examinations, who were admitted to one of 19 European centres between July, 2001, and June, 2008. A clinical prediction rule based on age and neurological variables was derived from the international standards for neurological classification of spinal cord injury with a multivariate logistic regression model. Primary outcome measure 1 year after injury was independent indoor walking based on the Spinal Cord Independence Measure. Model performances were quantified with respect to discrimination (area under receiver-operating-characteristics curve [AUC]). Temporal validation was done in a second group of patients from July, 2008, to December, 2009. Findings Of 1442 patients with spinal cord injury, 492 had available outcome measures. A combination of age ( |
| doi_str_mv | 10.1016/S0140-6736(10)62276-3 |
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We developed a reliable, validated prediction rule to assess a patient's chances of walking independently after such injury. Methods We undertook a longitudinal cohort study of adult patients with traumatic spinal cord injury, with early (within the first 15 days after injury) and late (1-year follow-up) clinical examinations, who were admitted to one of 19 European centres between July, 2001, and June, 2008. A clinical prediction rule based on age and neurological variables was derived from the international standards for neurological classification of spinal cord injury with a multivariate logistic regression model. Primary outcome measure 1 year after injury was independent indoor walking based on the Spinal Cord Independence Measure. Model performances were quantified with respect to discrimination (area under receiver-operating-characteristics curve [AUC]). Temporal validation was done in a second group of patients from July, 2008, to December, 2009. Findings Of 1442 patients with spinal cord injury, 492 had available outcome measures. A combination of age (<65 vs ≥65 years), motor scores of the quadriceps femoris (L3), gastrocsoleus (S1) muscles, and light touch sensation of dermatomes L3 and S1 showed excellent discrimination in distinguishing independent walkers from dependent walkers and non-walkers (AUC 0·956, 95% CI 0·936–0·976, p<0·0001). Temporal validation in 99 patients confirmed excellent discriminating ability of the prediction rule (AUC 0·967, 0·939–0·995, p<0·0001). Interpretation Our prediction rule, including age and four neurological tests, can give an early prognosis of an individual's ability to walk after traumatic spinal cord injury, which can be used to set rehabilitation goals and might improve the ability to stratify patients in interventional trials. Funding Internationale Stiftung für Forschung in Paraplegie.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(10)62276-3</identifier><identifier>PMID: 21377202</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Abbreviated Injury Scale ; Adolescent ; Adult ; adults ; Age ; Age Factors ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Cerebrospinal fluid. Meninges. Spinal cord ; Classification ; clinical examination ; Clinical medicine ; Clinical trials ; Cohort Studies ; Disability Evaluation ; Female ; General aspects ; Humans ; Injuries ; Internal Medicine ; International standards ; Longitudinal Studies ; Male ; Medical sciences ; Middle Aged ; Miscellaneous ; model validation ; Mortality ; Multivariate Analysis ; Muscles ; Nervous system (semeiology, syndromes) ; Neurologic Examination - methods ; Neurology ; patients ; Physicians ; planning ; prediction ; Predictive Value of Tests ; Prognosis ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; quadriceps muscle ; Recovery of Function - physiology ; Regression analysis ; Rehabilitation ; spinal cord ; Spinal cord injuries ; Spinal Cord Injuries - rehabilitation ; Spinal cord injury ; Tactile stimuli ; Validation studies ; Walking ; Walking - physiology ; Young Adult</subject><ispartof>The Lancet (British edition), 2011-03, Vol.377 (9770), p.1004-1010</ispartof><rights>Elsevier Ltd</rights><rights>2011 Elsevier Ltd</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 Elsevier Ltd. All rights reserved.</rights><rights>Copyright Elsevier Limited Mar 19-Mar 25, 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c651t-c7f1753072a08bb39e19990484f7b06fd7d56f465655ce80bceac4b19fd420013</citedby><cites>FETCH-LOGICAL-c651t-c7f1753072a08bb39e19990484f7b06fd7d56f465655ce80bceac4b19fd420013</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/857846035?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,782,786,3554,27933,27934,46004,64394,64396,64398,72478</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23955132$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21377202$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van Middendorp, Joost J, Dr</creatorcontrib><creatorcontrib>Hosman, Allard JF, MD</creatorcontrib><creatorcontrib>Donders, A Rogier T, PhD</creatorcontrib><creatorcontrib>Pouw, Martin H, MD</creatorcontrib><creatorcontrib>Ditunno, John F, Prof</creatorcontrib><creatorcontrib>Curt, Armin, Prof</creatorcontrib><creatorcontrib>Geurts, Alexander CH, Prof</creatorcontrib><creatorcontrib>Van de Meent, Hendrik, MD</creatorcontrib><creatorcontrib>for the EM-SCI Study Group</creatorcontrib><creatorcontrib>EM-SCI Study Group</creatorcontrib><title>A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Summary Background Traumatic spinal cord injury is a serious disorder in which early prediction of ambulation is important to counsel patients and to plan rehabilitation. We developed a reliable, validated prediction rule to assess a patient's chances of walking independently after such injury. Methods We undertook a longitudinal cohort study of adult patients with traumatic spinal cord injury, with early (within the first 15 days after injury) and late (1-year follow-up) clinical examinations, who were admitted to one of 19 European centres between July, 2001, and June, 2008. A clinical prediction rule based on age and neurological variables was derived from the international standards for neurological classification of spinal cord injury with a multivariate logistic regression model. Primary outcome measure 1 year after injury was independent indoor walking based on the Spinal Cord Independence Measure. Model performances were quantified with respect to discrimination (area under receiver-operating-characteristics curve [AUC]). Temporal validation was done in a second group of patients from July, 2008, to December, 2009. Findings Of 1442 patients with spinal cord injury, 492 had available outcome measures. A combination of age (<65 vs ≥65 years), motor scores of the quadriceps femoris (L3), gastrocsoleus (S1) muscles, and light touch sensation of dermatomes L3 and S1 showed excellent discrimination in distinguishing independent walkers from dependent walkers and non-walkers (AUC 0·956, 95% CI 0·936–0·976, p<0·0001). Temporal validation in 99 patients confirmed excellent discriminating ability of the prediction rule (AUC 0·967, 0·939–0·995, p<0·0001). Interpretation Our prediction rule, including age and four neurological tests, can give an early prognosis of an individual's ability to walk after traumatic spinal cord injury, which can be used to set rehabilitation goals and might improve the ability to stratify patients in interventional trials. Funding Internationale Stiftung für Forschung in Paraplegie.</description><subject>Abbreviated Injury Scale</subject><subject>Adolescent</subject><subject>Adult</subject><subject>adults</subject><subject>Age</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Cerebrospinal fluid. Meninges. Spinal cord</subject><subject>Classification</subject><subject>clinical examination</subject><subject>Clinical medicine</subject><subject>Clinical trials</subject><subject>Cohort Studies</subject><subject>Disability Evaluation</subject><subject>Female</subject><subject>General aspects</subject><subject>Humans</subject><subject>Injuries</subject><subject>Internal Medicine</subject><subject>International standards</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>model validation</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Muscles</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurologic Examination - methods</subject><subject>Neurology</subject><subject>patients</subject><subject>Physicians</subject><subject>planning</subject><subject>prediction</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>quadriceps muscle</subject><subject>Recovery of Function - physiology</subject><subject>Regression analysis</subject><subject>Rehabilitation</subject><subject>spinal cord</subject><subject>Spinal cord injuries</subject><subject>Spinal Cord Injuries - rehabilitation</subject><subject>Spinal cord injury</subject><subject>Tactile stimuli</subject><subject>Validation studies</subject><subject>Walking</subject><subject>Walking - physiology</subject><subject>Young Adult</subject><issn>0140-6736</issn><issn>1474-547X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkktv1DAURiMEotPCTwAsJERZBK7fCQtQVfGSKrEoldhZjmMXD0k8tZNK8-9xJtNB6gJWlq_PPbLv56J4huEtBizeXQJmUApJxSmGN4IQKUr6oFhhJlnJmfz5sFgdkKPiOKU1ADAB_HFxRDCVkgBZFfEMmc4P3ugObaJtvRl9GFCcOotciEj3zdTpXS1Mowm9TUi70UY0Rj31-cSgtPFDbjchtsgP6ylu3yONujBc-3Fq92e_QhxRyvvtk-KR012yT_frSXH1-dOP86_lxfcv387PLkojOB5LIx2WnIIkGqqmobXFdV0Dq5iTDQjXypYLxwQXnBtbQWOsNqzBtWsZAcD0pHi9eDcx3Ew2jar3ydiu04MNU1IVr0jFgdaZPP0nmQcua0EJpxl9eQ9dhynmJ84-WeX5Up4hvkAmhpSidWoTfa_jNptmmVC79NQczVzapadm-fO9fGp62x667uLKwKs9oFNOzEU9GJ_-crTmHNOZe7FwTgelr2Nmri4JYJ7nQmoKLBMfF8LmBG69jSoZbweTf0C0ZlRt8P-97Id7hruP9NtubTqMBatEFCyS2YFhZ6D0D2S81Ew</recordid><startdate>20110319</startdate><enddate>20110319</enddate><creator>van Middendorp, Joost J, Dr</creator><creator>Hosman, Allard JF, MD</creator><creator>Donders, A Rogier T, PhD</creator><creator>Pouw, Martin H, MD</creator><creator>Ditunno, John F, Prof</creator><creator>Curt, Armin, Prof</creator><creator>Geurts, Alexander CH, Prof</creator><creator>Van de Meent, Hendrik, MD</creator><general>Elsevier Ltd</general><general>Elsevier</general><general>Elsevier Limited</general><scope>FBQ</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TT</scope><scope>0TZ</scope><scope>0U~</scope><scope>3V.</scope><scope>7QL</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88C</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8C1</scope><scope>8C2</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>KB~</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>20110319</creationdate><title>A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study</title><author>van Middendorp, Joost J, Dr ; Hosman, Allard JF, MD ; Donders, A Rogier T, PhD ; Pouw, Martin H, MD ; Ditunno, John F, Prof ; Curt, Armin, Prof ; Geurts, Alexander CH, Prof ; Van de Meent, Hendrik, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c651t-c7f1753072a08bb39e19990484f7b06fd7d56f465655ce80bceac4b19fd420013</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Abbreviated Injury Scale</topic><topic>Adolescent</topic><topic>Adult</topic><topic>adults</topic><topic>Age</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Cerebrospinal fluid. Meninges. Spinal cord</topic><topic>Classification</topic><topic>clinical examination</topic><topic>Clinical medicine</topic><topic>Clinical trials</topic><topic>Cohort Studies</topic><topic>Disability Evaluation</topic><topic>Female</topic><topic>General aspects</topic><topic>Humans</topic><topic>Injuries</topic><topic>Internal Medicine</topic><topic>International standards</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Miscellaneous</topic><topic>model validation</topic><topic>Mortality</topic><topic>Multivariate Analysis</topic><topic>Muscles</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurologic Examination - methods</topic><topic>Neurology</topic><topic>patients</topic><topic>Physicians</topic><topic>planning</topic><topic>prediction</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>quadriceps muscle</topic><topic>Recovery of Function - physiology</topic><topic>Regression analysis</topic><topic>Rehabilitation</topic><topic>spinal cord</topic><topic>Spinal cord injuries</topic><topic>Spinal Cord Injuries - rehabilitation</topic><topic>Spinal cord injury</topic><topic>Tactile stimuli</topic><topic>Validation studies</topic><topic>Walking</topic><topic>Walking - physiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van Middendorp, Joost J, Dr</creatorcontrib><creatorcontrib>Hosman, Allard JF, MD</creatorcontrib><creatorcontrib>Donders, A Rogier T, PhD</creatorcontrib><creatorcontrib>Pouw, Martin H, MD</creatorcontrib><creatorcontrib>Ditunno, John F, Prof</creatorcontrib><creatorcontrib>Curt, Armin, Prof</creatorcontrib><creatorcontrib>Geurts, Alexander CH, Prof</creatorcontrib><creatorcontrib>Van de Meent, Hendrik, 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study</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>2011-03-19</date><risdate>2011</risdate><volume>377</volume><issue>9770</issue><spage>1004</spage><epage>1010</epage><pages>1004-1010</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>Summary Background Traumatic spinal cord injury is a serious disorder in which early prediction of ambulation is important to counsel patients and to plan rehabilitation. We developed a reliable, validated prediction rule to assess a patient's chances of walking independently after such injury. Methods We undertook a longitudinal cohort study of adult patients with traumatic spinal cord injury, with early (within the first 15 days after injury) and late (1-year follow-up) clinical examinations, who were admitted to one of 19 European centres between July, 2001, and June, 2008. A clinical prediction rule based on age and neurological variables was derived from the international standards for neurological classification of spinal cord injury with a multivariate logistic regression model. Primary outcome measure 1 year after injury was independent indoor walking based on the Spinal Cord Independence Measure. Model performances were quantified with respect to discrimination (area under receiver-operating-characteristics curve [AUC]). Temporal validation was done in a second group of patients from July, 2008, to December, 2009. Findings Of 1442 patients with spinal cord injury, 492 had available outcome measures. A combination of age (<65 vs ≥65 years), motor scores of the quadriceps femoris (L3), gastrocsoleus (S1) muscles, and light touch sensation of dermatomes L3 and S1 showed excellent discrimination in distinguishing independent walkers from dependent walkers and non-walkers (AUC 0·956, 95% CI 0·936–0·976, p<0·0001). Temporal validation in 99 patients confirmed excellent discriminating ability of the prediction rule (AUC 0·967, 0·939–0·995, p<0·0001). Interpretation Our prediction rule, including age and four neurological tests, can give an early prognosis of an individual's ability to walk after traumatic spinal cord injury, which can be used to set rehabilitation goals and might improve the ability to stratify patients in interventional trials. Funding Internationale Stiftung für Forschung in Paraplegie.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>21377202</pmid><doi>10.1016/S0140-6736(10)62276-3</doi><tpages>7</tpages></addata></record> |
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| ispartof | The Lancet (British edition), 2011-03, Vol.377 (9770), p.1004-1010 |
| issn | 0140-6736 1474-547X |
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| subjects | Abbreviated Injury Scale Adolescent Adult adults Age Age Factors Aged Aged, 80 and over Biological and medical sciences Cerebrospinal fluid. Meninges. Spinal cord Classification clinical examination Clinical medicine Clinical trials Cohort Studies Disability Evaluation Female General aspects Humans Injuries Internal Medicine International standards Longitudinal Studies Male Medical sciences Middle Aged Miscellaneous model validation Mortality Multivariate Analysis Muscles Nervous system (semeiology, syndromes) Neurologic Examination - methods Neurology patients Physicians planning prediction Predictive Value of Tests Prognosis Public health. Hygiene Public health. Hygiene-occupational medicine quadriceps muscle Recovery of Function - physiology Regression analysis Rehabilitation spinal cord Spinal cord injuries Spinal Cord Injuries - rehabilitation Spinal cord injury Tactile stimuli Validation studies Walking Walking - physiology Young Adult |
| title | A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-02T00%3A01%3A12IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=A%20clinical%20prediction%20rule%20for%20ambulation%20outcomes%20after%20traumatic%20spinal%20cord%20injury:%20a%20longitudinal%20cohort%20study&rft.jtitle=The%20Lancet%20(British%20edition)&rft.au=van%20Middendorp,%20Joost%20J,%20Dr&rft.aucorp=for%20the%20EM-SCI%20Study%20Group&rft.date=2011-03-19&rft.volume=377&rft.issue=9770&rft.spage=1004&rft.epage=1010&rft.pages=1004-1010&rft.issn=0140-6736&rft.eissn=1474-547X&rft.coden=LANCAO&rft_id=info:doi/10.1016/S0140-6736(10)62276-3&rft_dat=%3Cproquest_cross%3E858285039%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=857846035&rft_id=info:pmid/21377202&rft_els_id=1_s2_0_S0140673610622763&rfr_iscdi=true |