Division of Spinal Cord Injury, BG-University Hospital Bergmannsheil, Bochum, Germany.
Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Bochum, Germany.
Spine (Phila Pa 1976). 2018 Nov 15;43(22):1572-1578. doi: 10.1097/BRS.0000000000002680.
A case-control study; clinical prediction rule.
The aim of this study was to construct and internally validate a clinical prediction rule to identify patients at high risk of developing heterotopic ossification (HO) after spinal cord injury (SCI).
HO after SCI can lead to loss of joint mobility, loss of function, peripheral nerve entrapment, and pressure sores. HO is usually diagnosed on the basis of clinical symptoms, as no laboratory tests are yet available to identify patients with early HO formation. Risk factors include a complete SCI; patient age; spasticity; urinary tract infection (UTI); pneumonia; pelvic trauma; cervical or thoracic injury; and pressure sores.
We analyzed a total of 558 patients with SCI, of whom 221 developed HO of the hip. A parametric survival model was fitted to estimate the probability of developing HO of the hip within 3 months of a SCI. Hazard ratios (HRs) calculation, internal validation, calibration, and model reduction were performed over 200 bootstrapped resamples. A risk score for clinical used was developed.
Risk factors contributing to the risk score were completeness of the injury, age, sex, UTI, spasticity, and pneumonia. The model demonstrated good discrimination (AUC = 0.72). According to the risk score quintiles, the risk of developing HO after SCI was 1.0 for persons with a score of 0 to 17 and increased 2.47-fold for persons with a score of 1 to 21, 4.75-fold for persons with a score of 22 to 27, 6.95-fold for persons with a score of 28 to 31, and 9.23-fold for persons with a score of 32-35.
The risk score demonstrated good discrimination in predicting the occurrence of HO within 3 months of a SCI. Further development and validation of the model in other populations is warranted.
病例对照研究；临床预测规则。
本研究旨在构建和内部验证一种临床预测规则，以识别脊髓损伤（SCI）后发生异位骨化（HO）风险较高的患者。
SCI 后发生的 HO 可导致关节活动度丧失、功能丧失、周围神经受压和压疮。HO 通常基于临床症状诊断，因为目前尚无实验室检查可用于识别早期 HO 形成的患者。危险因素包括完全性 SCI、患者年龄、痉挛、尿路感染（UTI）、肺炎、骨盆创伤、颈椎或胸椎损伤以及压疮。
我们分析了总共 558 例 SCI 患者，其中 221 例发生了髋关节 HO。采用参数生存模型估计 SCI 后 3 个月内发生髋关节 HO 的概率。通过 200 次 bootstrap 重采样进行危险比（HR）计算、内部验证、校准和模型简化。开发了用于临床的风险评分。
导致风险评分的危险因素包括损伤的完整性、年龄、性别、UTI、痉挛和肺炎。该模型具有良好的判别能力（AUC=0.72）。根据风险评分五分位数，SCI 后发生 HO 的风险对于评分 0-17 的患者为 1.0，评分 1-21 的患者风险增加 2.47 倍，评分 22-27 的患者风险增加 4.75 倍，评分 28-31 的患者风险增加 6.95 倍，评分 32-35 的患者风险增加 9.23 倍。
风险评分在预测 SCI 后 3 个月内 HO 的发生方面具有良好的判别能力。需要进一步在其他人群中开发和验证该模型。
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