1 Hôpital du Sacré-Cœur de Montréal , Montréal, Quebec, Canada .
2 Department of Medicine, Faculty of Medicine, University of Montréal , Montréal, Quebec, Canada .
J Neurotrauma. 2018 Aug 1;35(15):1705-1725. doi: 10.1089/neu.2017.5403. Epub 2018 Apr 17.
Accurately predicting functional recovery is an asset for all clinicians and decision makers involved in the care of patients with acute traumatic spinal cord injury (TSCI). Unfortunately, there is a lack of information on the relative importance of significant predictors of global functional outcome. There is also a need for identifying functional predictors that can be timely optimized by the medical and rehabilitation teams throughout the hospitalizations phases. The main objective of this work was to systematically review and rate early factors that are consistently and independently associated with global functional outcome in individuals with TSCI. A literature search using MEDLINE, EMBASE, and Cochrane databases from January 1, 1970 to April 1, 2017 was performed. Two authors independently reviewed the titles and abstracts yielded by this literature search and subsequently selected studies to be included based on predetermined eligibility criteria. Disagreements were resolved by a consensus-based discussion, and if not, by an external reviewer. Data were extracted by three independent reviewers using a standardized table. The quality of evidence of the individual studies was assessed based on the Oxford Center for Evidence-Based Medicine modified by Wright and colleagues (2000) as well as the National Institutes of Health (2014). Fifteen articles identifying early clinical predictors of functional outcome using multiple regression analyses were included in this systematic review. Based on the compiled data, this review proposes a rating of early factors associated to global functional outcome according to their importance and their potential to be modified by the medical/rehabilitation team throughout the early phases of hospitalization. It also proposes a new conceptual framework that illustrates the impact of specific categories of factors and their interaction with each other. Ultimately, this review aims to guide clinicians and researchers in improving the continuum of care throughout early phases post-SCI.
准确预测功能恢复对于所有参与急性创伤性脊髓损伤（TSCI）患者治疗的临床医生和决策者都是有益的。不幸的是，关于对全球功能结局有显著影响的预测因子的相对重要性的信息不足。还需要确定可以由医疗和康复团队在整个住院阶段及时优化的功能预测因子。这项工作的主要目的是系统地回顾和评估与 TSCI 个体的全球功能结局一致且独立相关的早期因素。使用 MEDLINE、EMBASE 和 Cochrane 数据库从 1970 年 1 月 1 日至 2017 年 4 月 1 日进行了文献检索。两名作者独立审查了该文献检索产生的标题和摘要，随后根据预先确定的纳入标准选择要纳入的研究。通过基于共识的讨论解决分歧，如果无法解决，则由外部评审员解决。三名独立审查员使用标准化表格提取数据。根据牛津循证医学中心（由 Wright 等人于 2000 年修订）和美国国立卫生研究院（2014 年）对个别研究的证据质量进行评估。本系统评价共纳入了 15 篇使用多元回归分析确定功能结局早期临床预测因子的文章。根据汇编的数据，本综述根据其重要性以及医疗/康复团队在住院早期阶段对其进行修改的潜力，对与全球功能结局相关的早期因素进行了评分。它还提出了一个新的概念框架，说明了特定类别的因素及其相互作用的影响。最终，本综述旨在指导临床医生和研究人员在 SCI 后早期阶段改善护理连续性。
