Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
PLoS One. 2019 Mar 14;14(3):e0213510. doi: 10.1371/journal.pone.0213510. eCollection 2019.
To develop and internally validate the PROgnosis of functional recovery after Trauma (PRO-Trauma) prediction model.
A prospective single-center longitudinal cohort study. Patients were assessed at 6 weeks and 12 months post-injury.
Patients that presented at the emergency department with an acute traumatic injury, were prompted for participation. Patients that completed the assessments at 6 weeks and 12 months post injury were included. Exclusion criteria: age < 18, age > 65, pathologic fractures, injuries that resulted in severe neurologic deficits. The predicted outcome, functional recovery, was defined as a Short Musculoskeletal Function Assessment (SMFA-NL) Problems with Daily Activities (PDA) subscale ≤ 12.2 points at 12 months post-injury (Dutch population norm). Predictors were: gender, age, living with partner, number of chronic health conditions, SMFA-NL PDA score 6 weeks post-injury, ICU admission, length of stay in hospital, injury severity score, occurrence of complications and treatment type. All predictors were obtained before 6 weeks post-injury. Missing data were multiply imputed. Predictor variables were selected using backward stepwise multivariable logistic regression. Hosmer-Lemeshow tests were used to evaluate calibration. Bootstrap resampling was used to internally validate the final model.
A total of 246 patients were included, of which 104 (44%) showed functional recovery. The predictors in the final PRO-Trauma model were: living with partner, the number of chronic health conditions, SMFA-NL PDA subscale score at 6 weeks post-injury and length of stay in hospital. The apparent R2 was 0.33 [0.33;0.34], the c-statistic was 0.79 [0.79;0.80]. Hosmer-Lemeshow test indicated good calibration (p = 0.92). Optimism-corrected R2 was 0.28 [0.27;0.29] and the optimism-corrected Area Under the Curve was 0.77 [0.77;0.77].
The PRO-Trauma prediction model can be used to obtain valid predictions of attaining functional recovery after trauma at 12 months post-injury. The PRO-Trauma prediction model showed acceptable calibration and discrimination.
开发和内部验证创伤后功能恢复的预测模型（PRO-Trauma）。
前瞻性单中心纵向队列研究。患者在受伤后 6 周和 12 个月进行评估。
在急诊科就诊的急性创伤患者被提示参与。完成受伤后 6 周和 12 个月评估的患者被纳入。排除标准：年龄<18 岁，年龄>65 岁，病理性骨折，导致严重神经功能缺损的损伤。预测结果，功能恢复，定义为在受伤后 12 个月时短肌肉骨骼功能评估（SMFA-NL）日常生活问题（PDA）子量表≤12.2 分（荷兰人群正常值）。预测因子：性别、年龄、与伴侣同住、慢性健康状况数量、受伤后 6 周时的 SMFA-NL PDA 评分、入住 ICU、住院时间、损伤严重程度评分、并发症发生和治疗类型。所有预测因子均在受伤后 6 周前获得。缺失数据采用多重插补法。使用向后逐步多变量逻辑回归选择预测变量。Hosmer-Lemeshow 检验用于评估校准。Bootstrap 重采样用于内部验证最终模型。
共纳入 246 例患者，其中 104 例（44%）功能恢复。PRO-Trauma 模型中的预测因子为：与伴侣同住、慢性健康状况数量、受伤后 6 周时的 SMFA-NL PDA 子量表评分和住院时间。明显的 R2 为 0.33[0.33；0.34]，C 统计量为 0.79[0.79；0.80]。Hosmer-Lemeshow 检验表明校准良好（p=0.92）。校正后的 R2 为 0.28[0.27；0.29]，校正后的曲线下面积为 0.77[0.77；0.77]。
PRO-Trauma 预测模型可用于在受伤后 12 个月时对创伤后功能恢复进行有效预测。PRO-Trauma 预测模型具有可接受的校准和区分能力。
