Volitional Voiding of the Bladder after Spinal Cord Injury: Validation of Bilateral Lower Extremity Motor Function as a Key Predictor

Elliott, Christopher S.; Dallas, Kai; Zlatev, Dimitar V.; Comiter, Craig V.; Crew, James; Shem, Kazuko

doi:10.1016/j.juro.2018.02.064

Cited by 18 publications

(35 citation statements)

References 14 publications

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“…These articles have primarily focused on independence in ambulation [21], upper limb function [22], bladder function [23], and bowel function [10]. Further, only the studies that have created prognostic models for ambulation and bladder function have been externally validated on datasets not used to construct the original models [24,25]. This article is the first study to successfully evaluate the external validity of the model for bowel function.…”

Section: Discussionmentioning

confidence: 99%

Prediction of independence in bowel function after spinal cord injury: validation of a logistic regression model

2020

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Study design Retrospective analysis of prospectively collected data. Objectives Recently, logistic regression models were developed to predict independence in bowel function 1 year after spinal cord injury (SCI) on a multicenter European SCI (EMSCI) dataset. Here, we evaluated the external validity of these models against a prospectively accrued North American SCI dataset. Setting Twenty-five SCI centers in the United States and Canada. Methods Two logistic regression models developed by the EMSCI group were applied to data for 277 patients derived from three prospective multicenter SCI studies based in North America. External validation was evaluated for both models by assessing their discrimination, calibration, and clinical utility. Discrimination and calibration were assessed using ROC curves and calibration curves, respectively, while clinical utility was assessed using decision curve analysis. Results The simplified logistic regression model, which used baseline total motor score as the predictor, demonstrated the best performance, with an area under the ROC curve of 0.869 (95% confidence interval: 0.826–0.911), a sensitivity of 75.5%, and a specificity of 88.5%. Moreover, the model was well calibrated across the full range of observed probabilities and displayed superior clinical benefit on the decision curve. Conclusions A logistic regression model using baseline total motor score as a predictor of independent bowel function 1 year after SCI was successfully validated against an external dataset. These findings provide evidence supporting the use of this model to enhance the care for individuals with SCI.

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Section: Discussionmentioning

confidence: 99%

Prediction of independence in bowel function after spinal cord injury: validation of a logistic regression model

2020

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“…Of note, we recently applied the same methodology for deriving a prediction model of bladder function after traumatic SCI. 16 That model was subsequently validated in a large, independent cohort, based on data from the National Spinal Cord Injury Database, 18 on US patients with traumatic SCIs and, additionally, on patients with ischemic SCIs. 17…”

Section: Discussionmentioning

confidence: 99%

“…Although there are valid prediction models for locomotion, 14 upper-limb function, 15 and bladder function, 16-18 no similar tool is available for bowel function. Thus, we aimed to derive and validate a model for predicting the achievement of independent bowel management, with reliable bowel movements and continence, at 1 year after traumatic SCI.…”

Section: Introductionmentioning

confidence: 99%

Bowel Outcome Prediction After Traumatic Spinal Cord Injury: Longitudinal Cohort Study

Pavese

Bachmann

Schubert

et al. 2019

Neurorehabil Neural Repair

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Background. Predicting functional outcomes after traumatic spinal cord injury (SCI) is essential for counseling, rehabilitation planning, and discharge. Moreover, the outcome prognosis is crucial for patient stratification when designing clinical trials. However, no valid prediction rule is currently available for bowel outcomes after a SCI. Objective. To generate a model for predicting the achievement of independent, reliable bowel management at 1 year after traumatic SCI. Methods. We performed multivariable logistic regression analyses of data for 1250 patients with traumatic SCIs that were included in the European Multicenter Study about Spinal Cord Injury. The resulting model was prospectively validated on data for 186 patients. As potential predictors, we evaluated age, sex, and variables from the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and the Spinal Cord Independence Measure (SCIM), measured within 40 days of the injury. A positive outcome at 1 year post-SCI was assessed with item 7 of the SCIM. Results. The model relied on a single predictor, the ISNCSCI total motor score—that is, the sum of muscle strengths in 5 key muscle groups in each limb. The area under the receiver operating characteristics curve (aROC) was 0.837 (95% CI: 0.815-0.859). The prospective validation confirmed high predictive power: aROC = 0.817 (95% CI: 0.754-0.881). Conclusions. We generated a valid model for predicting independent, reliable bowel management at 1 year after traumatic SCI. Its application could improve counseling, optimize patient-tailored rehabilitation planning, and become crucial for appropriate patient stratification in future clinical trials.

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“…Long-time treatment, cost of care and economic losses can affect the patients and their families, raising social and physiological issues. Typically, >50% of patients may not regain their normal function and daily life (3). Healthy young individuals of 15-25 years are most commonly affected; because of this, SCI is a serious worldwide health concern (3).…”

Section: Introductionmentioning

confidence: 99%

Acute spinal cord injury: Pathophysiology and pharmacological intervention (Review)

et al. 2021

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Spinal cord injury (SCI) is one of the most debilitating of all the traumatic conditions that afflict individuals. For a number of years, extensive studies have been conducted to clarify the molecular mechanisms of SCI. Experimental and clinical studies have indicated that two phases, primary damage and secondary damage, are involved in SCI. The initial mechanical damage is caused by local impairment of the spinal cord. In addition, the fundamental mechanisms are associated with hyperflexion, hyperextension, axial loading and rotation. By contrast, secondary injury mechanisms are led by systemic and cellular factors, which may also be initiated by the primary injury. Although significant advances in supportive care have improved clinical outcomes in recent years, a number of studies continue to explore specific pharmacological therapies to minimize SCI. The present review summarized some important pathophysiologic mechanisms that are involved in SCI and focused on several pharmacological and non-pharmacological therapies, which have either been previously investigated or have a potential in the management of this debilitating injury in the near future.

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Volitional Voiding of the Bladder after Spinal Cord Injury: Validation of Bilateral Lower Extremity Motor Function as a Key Predictor

Abstract: Our study verifies the validity of the EMSCI predictive model of volitional voiding after spinal cord injury. The differing performance of lower extremity motor scores in various AIS classifications should be noted.

Cited by 18 publications

References 14 publications

Prediction of independence in bowel function after spinal cord injury: validation of a logistic regression model

Prediction of independence in bowel function after spinal cord injury: validation of a logistic regression model

Bowel Outcome Prediction After Traumatic Spinal Cord Injury: Longitudinal Cohort Study

Acute spinal cord injury: Pathophysiology and pharmacological intervention (Review)

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