Prediction of bowel management independence after ischemic spinal cord injury

Pavese, Chiara; Scivoletto, Giorgio; Puci, Mariangela Valentina; Abel, Rainer; Curt, Armin; Maier, Doris; Rupp, Rüdiger; Schubert, Martin; Weidner, Norbert; Montomoli, Cristina; Kessler, Thomas M.

doi:10.23736/s1973-9087.22.07366-x

Cited by 6 publications

(4 citation statements)

References 27 publications

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“…A subsequent study reaffirmed the prognostic value of total motor score for the recovery of bowel function, not only when used as an early predictor, but also when evaluated three months after traumatic SCI, a time-point coinciding in many cases with the end of the rehabilitation phase [56]. Moreover, the original model showed a good performance in the prognostication of bowel function also in patients with SCI of ischemic etiology [57]. In the previously mentioned study based on data from the United States National Spinal Cord Injury Model Systems (SCIMS) Database, the authors also derived a model to predict bowel management one year after traumatic SCI [45].…”

Section: Prediction Of Bowel Functionmentioning

confidence: 84%

Section: Prediction Of Genitourinary and Gastroenteric Outcomesmentioning

confidence: 99%

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Prediction of Lower Urinary Tract, Sexual, and Bowel Function, and Autonomic Dysreflexia after Spinal Cord Injury

Pavese

Kessler

2023

Biomedicines

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Spinal cord injury (SCI) produces damage to the somatic and autonomic pathways that regulate lower urinary tract, sexual, and bowel function, and increases the risk of autonomic dysreflexia. The recovery of these functions has a high impact on health, functioning, and quality of life and is set as the utmost priority by patients. The application of reliable models to predict lower urinary tract, sexual, and bowel function, and autonomic dysreflexia is important for guiding counseling, rehabilitation, and social reintegration. Moreover, a reliable prediction is essential for designing future clinical trials to optimize patients’ allocation to different treatment groups. To date, reliable and simple algorithms are available to predict lower urinary tract and bowel outcomes after traumatic and ischemic SCI. Previous studies identified a few risk factors to develop autonomic dysreflexia, albeit a model for prediction still lacks. On the other hand, there is an urgent need for a model to predict the evolution of sexual function. The aim of this review is to examine the available knowledge and models for the prediction of lower urinary tract, sexual, and bowel function, and autonomic dysreflexia after SCI, and critically discuss the research priorities in these fields.

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Section: Prediction Of Bowel Functionmentioning

confidence: 84%

Section: Prediction Of Genitourinary and Gastroenteric Outcomesmentioning

confidence: 99%

Prediction of Lower Urinary Tract, Sexual, and Bowel Function, and Autonomic Dysreflexia after Spinal Cord Injury

Pavese

Kessler

2023

Biomedicines

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“…The bootstrap method was employed to sample 1000 times and calculate the aROC to validate the predictive efficacy of the prediction score 41 . An aROC greater than 0.75 was considered indicative of relatively excellent predictive performance 42 . Calibration assessment involved the calibration curve, Hosmer–Lemeshow test, and Brier scores.…”

Section: Methodsmentioning

confidence: 99%

“… 41 An aROC greater than 0.75 was considered indicative of relatively excellent predictive performance. 42 Calibration assessment involved the calibration curve, Hosmer–Lemeshow test, and Brier scores. The Brier score, considering both calibration and discrimination, measured the mean‐squared difference between observed and predicted outcomes, ranging from 0.0 (perfect prediction) to 0.25 (poor prediction) in cases with a 50% outcome incidence.…”

Section: Methodsmentioning

confidence: 99%

Prediction of early bladder outcomes after spinal cord injury: The HALT score

Wu,

Xi,

et al. 2024

CNS Neurosci Ther

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AimsNeurogenic bladder (NB) is a prevalent and debilitating consequence of spinal cord injury (SCI). Indeed, the accurate prognostication of early bladder outcomes is crucial for patient counseling, rehabilitation goal setting, and personalized intervention planning.MethodsA retrospective exploratory analysis was conducted on a cohort of consecutive SCI patients admitted to a rehabilitation facility in China from May 2016 to December 2022. Demographic, clinical, and electrophysiological data were collected within 40 days post‐SCI, with bladder outcomes assessed at 3 months following SCI onset.ResultsThe present study enrolled 202 SCI patients with a mean age of 40.3 ± 12.3 years. At 3 months post‐SCI, 79 participants exhibited complete bladder emptying. Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analyses identified the H‐reflex of the soleus muscle, the American Spinal Injury Association Lower Extremity Motor Score (ASIA‐LEMS), and the time from lesion to rehabilitation facility (TLRF) as significant independent predictors for bladder emptying. A scoring system named HALT was developed, yielding a strong discriminatory performance with an area under the receiver operating characteristics curve (aROC) of 0.878 (95% CI: 0.823–0.933). A simplified model utilizing only the H‐reflex exhibited excellent discriminatory ability with an aROC of 0.824 (95% CI: 0.766–0.881). Both models demonstrated good calibration via the Hosmer–Lemeshow test and favorable clinical net benefits through decision curve analysis (DCA). In comparison to ASIA‐LEMS, both the HALT score and H‐reflex showed superior predictive accuracy for bladder outcome. Notably, in individuals with incomplete injuries, the HALT score (aROC = 0.973, 95% CI: 0.940–1.000) and the H‐reflex (aROC = 0.888, 95% CI: 0.807–0.970) displayed enhanced performance.ConclusionTwo reliable models, the HALT score and the H‐reflex, were developed to predict bladder outcomes as early as 3 months after SCI onset. Importantly, this study provides hitherto undocumented evidence regarding the predictive significance of the soleus H‐reflex in relation to bladder outcomes in SCI patients.

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Development and Validation of a Novel Nomogram for Predicting Mechanical Ventilation After Cervical Spinal Cord Injury

Liu,

Zhang

et al. 2024

Archives of Physical Medicine and Rehabilitation

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Prediction of bowel management independence after ischemic spinal cord injury

Cited by 6 publications

References 27 publications

Prediction of Lower Urinary Tract, Sexual, and Bowel Function, and Autonomic Dysreflexia after Spinal Cord Injury

Prediction of Lower Urinary Tract, Sexual, and Bowel Function, and Autonomic Dysreflexia after Spinal Cord Injury

Prediction of early bladder outcomes after spinal cord injury: The HALT score

Development and Validation of a Novel Nomogram for Predicting Mechanical Ventilation After Cervical Spinal Cord Injury

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