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创伤性脊髓损伤后一年神经源性膀胱恢复的预测模型

Prediction Model for Neurogenic Bladder Recovery One Year After Traumatic Spinal Cord Injury.

作者信息

El Sammak Sally, Michalopoulos Giorgos D, Arya Namrata, Bhandarkar Archis R, Moinuddin F M, Jarrah Ryan, Yolcu Yagiz U, Shoushtari Ali, Bydon Mohamad

机构信息

Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.

Department of Neurologic Surgery, Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Alix School of Medicine, Scottsdale, Phoenix, Arizona, USA.

出版信息

World Neurosurg. 2023 Nov;179:e222-e231. doi: 10.1016/j.wneu.2023.08.054. Epub 2023 Aug 21.

Abstract

INTRODUCTION

Neurogenic bladder is a common complication after spinal cord injury (SCI) that carries substantial burdens on the inflicted individual. The objective of this study is to build a prediction model for neurogenic bladder recovery 1 year after traumatic SCI.

METHODS

We queried the National Spinal Cord Injury Model Systems database for patients with traumatic SCI who had neurogenic bladder at the time of injury. The primary outcome of interest was the complete recovery of bladder function at 1 year. Multiple imputations were performed to generate replacement values for missing data, and the final imputed data were used for our analysis. A multivariable odds logistic regression model was developed for complete bladder recovery at 1 year.

RESULTS

We identified a total of 2515 patients with abnormal bladder function at baseline who had an annual follow-up. A total of 417 patients (16.6%) recovered bladder function in 1 year. Predictors of complete bladder recovery included the following baseline parameters: sacral sensation, American Spinal Injury Association (ASIA) impairment score, bowel function at baseline, voluntary sphincter contraction, anal sensation, S1 motor scores, and the number of days in the rehabilitation facility. The model performed with a discriminative capacity of 90.5%.

CONCLUSIONS

We developed a prediction model for the probability of complete bladder recovery 1 year after SCI. The model performed with a high discriminative capacity. This prediction model demonstrates potential utility in the counseling, research allocation, and management of individuals with SCI.

摘要

引言

神经源性膀胱是脊髓损伤(SCI)后常见的并发症,给患者带来沉重负担。本研究的目的是建立一个预测创伤性脊髓损伤后1年神经源性膀胱恢复情况的模型。

方法

我们查询了国家脊髓损伤模型系统数据库中受伤时患有神经源性膀胱的创伤性脊髓损伤患者。感兴趣的主要结局是1年后膀胱功能完全恢复。进行多次插补以生成缺失数据的替代值,并将最终插补数据用于我们的分析。开发了一个多变量优势逻辑回归模型来预测1年后膀胱功能的完全恢复情况。

结果

我们共确定了2515例基线膀胱功能异常且每年接受随访的患者。共有417例患者(16.6%)在1年内恢复了膀胱功能。膀胱功能完全恢复的预测因素包括以下基线参数:骶部感觉、美国脊髓损伤协会(ASIA)损伤评分、基线时的肠道功能、自主括约肌收缩、肛门感觉、S1运动评分以及在康复机构的天数。该模型的判别能力为90.5%。

结论

我们开发了一个预测脊髓损伤后1年膀胱功能完全恢复概率的模型。该模型具有较高的判别能力。这个预测模型在脊髓损伤患者的咨询、研究分配和管理方面显示出潜在的实用性。

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