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Clinical Prediction Rule Validation for Ambulation Outcome After Traumatic Spinal Cord Injury in a Spanish Population
Alejandro García-Rudolph1, Mark Andrew Wright, Jesus Benito
1Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain (Drs García-Rudolph, Benito, Vidal, Tormos, Opisso, and Murillo and Mr Wright); Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain (Drs García-Rudolph, Benito, Vidal, Tormos, Opisso, and Murillo, and Mr Wright); and Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain (Drs García-Rudolph, Benito, Vidal, Tormos, Opisso, and Murillo, and Mr Wright).
This study validates the Dutch Clinical Prediction Rule for predicting walking ability in traumatic spinal cord injury patients up to 90 days post-injury. The rule showed similar performance in a Spanish population, confirming its clinical utility.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Clinical Epidemiology
Background:
- Predicting walking ability after traumatic spinal cord injury (SCI) is crucial for patient outcomes.
- Existing predictive models, like the Dutch Clinical Prediction Rule (DCPR), are often validated with limited data and specific timeframes post-injury.
- The DCPR was originally validated using assessments within 15 days, but clinical practice often involves assessments between 11-55 days, and external validation for traumatic SCI with later assessments is limited.
Purpose of the Study:
- To externally validate the Dutch Clinical Prediction Rule for predicting long-term walking ability in traumatic spinal cord injury patients.
- To assess the performance of the DCPR using neurological assessments performed within 3-90 days post-injury.
- To compare the predictive accuracy using original logistic regression coefficients, original weighted coefficients, and re-estimated weighted coefficients from a Spanish population.
Main Methods:
- A retrospective study adhering to STROBE guidelines was conducted.
- Data from 298 adult patients with traumatic spinal cord injury admitted between 2010-2019 in Spain were analyzed.
- The Spinal Cord Independence Measure (SCIM) item-12 was utilized for assessing walking ability.
Main Results:
- Using original logistic regression coefficients (Equation 1), the model achieved 86.2% overall accuracy, 94.5% sensitivity, and 83.4% specificity (AUC = 0.939).
- Using original weighted coefficients (Equation 2), performance was similar: 86.2% accuracy, 93.2% sensitivity, and 83.9% specificity (AUC = 0.9392).
- Re-estimated weighted coefficients (Equation 3) from the Spanish population yielded 86.9% accuracy, 68.9% sensitivity, and 92.8% specificity (AUC = 0.939).
Conclusions:
- The Dutch Clinical Prediction Rule is validated in a Spanish traumatic spinal cord injury cohort with assessments up to 90 days post-injury.
- The rule demonstrated similar predictive performance when using original coefficients and when coefficients were re-estimated for the Spanish population.
- These findings support the broader applicability of the DCPR in clinical settings with delayed neurological assessments.
