ICORD (International Collaboration on Repair Discoveries), University of British Columbia, Vancouver, BC, Canada.
Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
J Spinal Cord Med. 2020 May;43(3):315-330. doi: 10.1080/10790268.2018.1527082. Epub 2018 Oct 9.
To identify early predictors and develop reliable, validated prediction models for development of problematic spasticity after traumatic spinal cord injury (SCI). Prospective cohort study of the Rick Hansen Spinal Cord Injury Registry (RHSCIR), retrospective review of inpatient medical charts. Quaternary trauma center, rehabilitation center, community settings. Individuals with traumatic SCI between March 1, 2005, and March 31, 2014, prospectively enrolled in the Vancouver site RHSCIR. None. Spasticity limiting function or requiring treatment (problematic spasticity) on the Spinal Cord Injury Health Questionnaire. In 350 patients, variables documented during hospitalization that predicted the development of problematic spasticity up to 5 years post-injury included: initial Glasgow Coma Scale; age at time of injury; admission to rehabilitation center; community discharge anti-spasticity medication prescription, neurological status, Penn Spasm Frequency Scale, and pain interference with quality of life, sleep, activities; greater change in AIS motor scores between admission and discharge. The predictive models had area under the receiver operating characteristic curve of 0.80 (95% CI 0.75, 0.85) in the development set ( = 244) and 0.84 (95% CI 0.74, 0.92) in the validation set ( = 106) for spasticity limiting function and 0.81 (95% CI 0.76, 0.85) in the development set and 0.85 (95% CI 0.77, 0.92) in the validation set for spasticity requiring treatment. Our prediction models provide an early prognosis of risk of developing problematic spasticity after traumatic SCI, which can be used to improve clinical spasticity management and assist research (e.g. risk stratification in interventional trials).
为了确定外伤性脊髓损伤（SCI）后痉挛性问题发展的早期预测指标，并建立可靠、有效的预测模型。这是一项 Rick Hansen 脊髓损伤注册研究（RHSCIR）的前瞻性队列研究，对住院病历进行回顾性审查。位于四级创伤中心、康复中心和社区环境。2005 年 3 月 1 日至 2014 年 3 月 31 日期间，前瞻性纳入温哥华 RHSCIR 的外伤性 SCI 个体。无。脊髓损伤健康问卷（SCI-HQ）上记录的痉挛限制功能或需要治疗（痉挛性问题）。在 350 名患者中，住院期间记录的变量可预测损伤后 5 年内出现痉挛性问题，包括：初始格拉斯哥昏迷量表（GCS）评分；损伤时的年龄；入住康复中心；社区出院时抗痉挛药物处方；神经状态、Penn 痉挛频率量表（PSFS）和疼痛对生活质量、睡眠、活动的干扰；入院和出院时 AIS 运动评分的变化。在发展组（ = 244）和验证组（ = 106）中，预测模型的受试者工作特征曲线下面积（AUC）分别为 0.80（95%CI 0.75，0.85）和 0.84（95%CI 0.74，0.92），用于预测限制功能的痉挛；在发展组和验证组中，预测模型的 AUC 分别为 0.81（95%CI 0.76，0.85）和 0.85（95%CI 0.77，0.92），用于预测需要治疗的痉挛。我们的预测模型提供了外伤性 SCI 后痉挛性问题发展风险的早期预后，可以用于改善临床痉挛管理，并协助研究（例如，干预试验中的风险分层）。
