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Updated: Jul 8, 2026
Establishing a Competing Risk Regression Nomogram Model for Survival Data
Published on: October 23, 2020
Development and validation of a nomogram for predicting the prognosis in children with spinal cord injuries
Bo Wang1, Liukun Xu1, Pengfei Zheng1
1Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China.
Insights
This study developed a reliable nomogram to predict 3-, 5-, and 7-year outcomes for pediatric spinal cord injury (SCI) patients, aiding in forecasting functional recovery using ASIA and FIM scores.
Area of Science:
- Pediatric neurology
- Rehabilitation medicine
- Biostatistics
Background:
- Spinal cord injury (SCI) in children presents significant long-term challenges.
- Accurate prognostic tools are crucial for managing pediatric SCI outcomes.
- Existing prediction models may lack specificity for pediatric populations.
Purpose of the Study:
- To develop and validate a precise nomogram for predicting 3-, 5-, and 7-year outcomes in pediatric SCI patients.
- To identify key prognostic determinants influencing functional recovery.
- To provide a tool for forecasting the American Spinal Injury Association (ASIA) and Functional Independence Assessment (FIM) scores.
Main Methods:
- A retrospective cohort of 224 pediatric SCI patients from China (2005-2020) was analyzed.
- Patients were divided into training and external validation sets.
- Cox hazard models identified prognostic factors, and a nomogram was constructed and validated using bootstrap techniques.
Main Results:
- The nomogram demonstrated strong predictive accuracy with C-indices of 0.924 (training) and 0.863 (external validation).
- High predictive value was observed for FIM-based predictions (C-index: 0.908).
- Calibration diagrams confirmed good agreement between predicted and actual ASIA outcomes.
Conclusions:
- The developed and validated nomogram is a dependable tool for forecasting long-term (3, 5, 7-year) ASIA and FIM outcomes in pediatric SCI.
- This prognostic instrument can aid clinicians in managing and understanding the recovery trajectory of children with SCI.
Aims:
This research aims to construct and verify an accurate nomogram for forecasting the 3-, 5-, and 7-year outcomes in pediatric patients afflicted with spinal cord injury (SCI).
Methods:
Pediatric patients with SCI from multiple hospitals in China, diagnosed between Jan 2005 and Jan 2020, were incorporated into this research. Half of these patients were arbitrarily chosen for training sets, and the other half were designated for external validation sets. The Cox hazard model was employed to pinpoint potential prognosis determinants related to the American Spinal Injury Association (ASIA) and Functional Independence Assessment (FIM) index. These determinants were then employed to formulate the prognostic nomogram. Subsequently, the bootstrap technique was applied to validate the derived model internally.
Results:
In total, 224 children with SCI were considered for the final evaluation, having a median monitoring duration of 68.0 months. The predictive nomogram showcased superior differentiation capabilities, yielding a refined C-index of 0.924 (95% CI: 0.883-0.965) for the training cohort and a C-index of 0.863 (95% CI: 0.735-0.933) for the external verification group. Additionally, when applying the aforementioned model to prognostic predictions as classified by the FIM, it demonstrated a high predictive value with a C-index of 0.908 (95% CI: 0.863-0.953). Moreover, the calibration diagrams indicated a consistent match between the projected and genuine ASIA outcomes across both sets.
Conclusion:
The crafted and verified prognostic nomogram emerges as a dependable instrument to foresee the 3-, 5-, and 7-year ASIA and FIM outcomes for children suffering from SCI.
