Development and Validation of a Nomogram for Predicting the Prognosis in Children with Spinal Cord Injuries

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2024 Mar 21

PMID 38509262

Authors

Bo Wang

Liukun Xu

Pengfei Zheng

Yapeng Zhang

Wangmi Liu

Yuntao Wang

Zhiqun Zhang

Affiliations

Soon will be listed here.

Abstract

Aims: This research aims to construct and verify an accurate nomogram for forecasting the 3-, 5-, and 7-year outcomes in pediatric patients afflicted with spinal cord injury (SCI).

Methods: Pediatric patients with SCI from multiple hospitals in China, diagnosed between Jan 2005 and Jan 2020, were incorporated into this research. Half of these patients were arbitrarily chosen for training sets, and the other half were designated for external validation sets. The Cox hazard model was employed to pinpoint potential prognosis determinants related to the American Spinal Injury Association (ASIA) and Functional Independence Assessment (FIM) index. These determinants were then employed to formulate the prognostic nomogram. Subsequently, the bootstrap technique was applied to validate the derived model internally.

Results: In total, 224 children with SCI were considered for the final evaluation, having a median monitoring duration of 68.0 months. The predictive nomogram showcased superior differentiation capabilities, yielding a refined C-index of 0.924 (95% CI: 0.883-0.965) for the training cohort and a C-index of 0.863 (95% CI: 0.735-0.933) for the external verification group. Additionally, when applying the aforementioned model to prognostic predictions as classified by the FIM, it demonstrated a high predictive value with a C-index of 0.908 (95% CI: 0.863-0.953). Moreover, the calibration diagrams indicated a consistent match between the projected and genuine ASIA outcomes across both sets.

Conclusion: The crafted and verified prognostic nomogram emerges as a dependable instrument to foresee the 3-, 5-, and 7-year ASIA and FIM outcomes for children suffering from SCI.

References

Eli I, Lerner D, Ghogawala Z . Acute Traumatic Spinal Cord Injury. Neurol Clin. 2021; 39(2):471-488. DOI: 10.1016/j.ncl.2021.02.004. View

Chay W, Kirshblum S . Predicting Outcomes After Spinal Cord Injury. Phys Med Rehabil Clin N Am. 2020; 31(3):331-343. DOI: 10.1016/j.pmr.2020.03.003. View

Attal N . Spinal cord injury pain. Rev Neurol (Paris). 2020; 177(5):606-612. DOI: 10.1016/j.neurol.2020.07.003. View

Alcantar-Garibay O, Incontri-Abraham D, Ibarra A . Spinal cord injury-induced cognitive impairment: a narrative review. Neural Regen Res. 2022; 17(12):2649-2654. PMC: 9165403. DOI: 10.4103/1673-5374.339475. View

Robertson K, Ashworth F . Spinal cord injury and pregnancy. Obstet Med. 2022; 15(2):99-103. PMC: 9277738. DOI: 10.1177/1753495X211011918. View

Cunha N, Malvea A, Sadat S, Ibrahim G, Fehlings M . Pediatric Spinal Cord Injury: A Review. Children (Basel). 2023; 10(9). PMC: 10530251. DOI: 10.3390/children10091456. View

Sharif S, Jazaib Ali M . Outcome Prediction in Spinal Cord Injury: Myth or Reality. World Neurosurg. 2020; 140:574-590. DOI: 10.1016/j.wneu.2020.05.043. View

Choi E, Gattas S, Brown N, Hong J, Limbo J, Chan A . Epidural electrical stimulation for spinal cord injury. Neural Regen Res. 2021; 16(12):2367-2375. PMC: 8374568. DOI: 10.4103/1673-5374.313017. View

Furlan J, Sakakibara B, Miller W, Krassioukov A . Global incidence and prevalence of traumatic spinal cord injury. Can J Neurol Sci. 2013; 40(4):456-64. DOI: 10.1017/s0317167100014530. View

10.

Ding W, Hu S, Wang P, Kang H, Peng R, Dong Y . Spinal Cord Injury: The Global Incidence, Prevalence, and Disability From the Global Burden of Disease Study 2019. Spine (Phila Pa 1976). 2022; 47(21):1532-1540. PMC: 9554757. DOI: 10.1097/BRS.0000000000004417. View

11.

Strom V, Manum G, Arora M, Joseph C, Kyriakides A, Le Fort M . Physical Health Conditions in Persons with Spinal Cord Injury Across 21 Countries Worldwide. J Rehabil Med. 2022; 54:jrm00302. PMC: 9272839. DOI: 10.2340/jrm.v54.2040. View

12.

Megia Garcia A, Serrano-Munoz D, Taylor J, Avendano-Coy J, Gomez-Soriano J . Transcutaneous Spinal Cord Stimulation and Motor Rehabilitation in Spinal Cord Injury: A Systematic Review. Neurorehabil Neural Repair. 2019; 34(1):3-12. DOI: 10.1177/1545968319893298. View

13.

Liu C, Liu Y, Ma B, Zhou M, Zhao X, Fu X . Mitochondrial regulatory mechanisms in spinal cord injury: A narrative review. Medicine (Baltimore). 2022; 101(46):e31930. PMC: 9678589. DOI: 10.1097/MD.0000000000031930. View

14.

Atkins K, Bickel C . Effects of functional electrical stimulation on muscle health after spinal cord injury. Curr Opin Pharmacol. 2021; 60:226-231. DOI: 10.1016/j.coph.2021.07.025. View

15.

Chen X, Li H . Neuronal reprogramming in treating spinal cord injury. Neural Regen Res. 2021; 17(7):1440-1445. PMC: 8771113. DOI: 10.4103/1673-5374.330590. View

16.

Fogarty M, Sieck G . Spinal cord injury and diaphragm neuromotor control. Expert Rev Respir Med. 2020; 14(5):453-464. PMC: 7176525. DOI: 10.1080/17476348.2020.1732822. View

17.

Wang J, Yang M, Meng M, Li Z . Clinical characteristics and treatment of spinal cord injury in children and adolescents. Chin J Traumatol. 2022; 26(1):8-13. PMC: 9912187. DOI: 10.1016/j.cjtee.2022.04.007. View

18.

Li C, Xiong W, Wan B, Kong G, Wang S, Wang Y . Role of peripheral immune cells in spinal cord injury. Cell Mol Life Sci. 2022; 80(1):2. PMC: 9729325. DOI: 10.1007/s00018-022-04644-0. View

19.

Kirshblum S, Snider B, Rupp R, Schmidt Read M . Updates of the International Standards for Neurologic Classification of Spinal Cord Injury: 2015 and 2019. Phys Med Rehabil Clin N Am. 2020; 31(3):319-330. DOI: 10.1016/j.pmr.2020.03.005. View

20.

Zheng Y, Mao Y, Yuan T, Xu D, Cheng L . Multimodal treatment for spinal cord injury: a sword of neuroregeneration upon neuromodulation. Neural Regen Res. 2020; 15(8):1437-1450. PMC: 7059565. DOI: 10.4103/1673-5374.274332. View