A clinical prediction rule for ambulation outcomes after traumatic XXXX : a longitudinal cohort study.

@entity1566 @entity1 @entity74
BACKGROUND: Traumatic @entity1566 is a @entity74 in which early prediction of ambulation is important to counsel @entity1 and to plan rehabilitation. We developed a reliable, validated prediction rule to assess a @entity1 's chances of walking independently after such injury. METHODS: We undertook a longitudinal cohort study of adult @entity1 with traumatic @entity1566 , with early (within the first 15 days after injury) and late (1-year follow-up) clinical examinations, who were admitted to one of 19 European centres between July, 2001, and June, 2008. A clinical prediction rule based on age and neurological variables was derived from the international standards for neurological classification of @entity1566 with a multivariate logistic regression model. Primary outcome measure 1 year after injury was independent indoor walking based on the Spinal Cord Independence Measure. Model performances were quantified with respect to discrimination (area under receiver-operating-characteristics curve [AUC]). Temporal validation was done in a second group of @entity1 from July, 2008, to December, 2009. FINDINGS: Of 1442 @entity1 with @entity1566 , 492 had available outcome measures. A combination of age (<65 vs >= 65 years), motor scores of the quadriceps femoris (L3), gastrocsoleus (S1) muscles, and light touch sensation of dermatomes L3 and S1 showed excellent discrimination in distinguishing independent walkers from dependent walkers and non-walkers (AUC 0  956, 95% CI 0  936-0  976, p<0  0001). Temporal validation in 99 @entity1 confirmed excellent discriminating ability of the prediction rule (AUC 0  967, 0  939-0  995, p<0  0001). INTERPRETATION: Our prediction rule, including age and four neurological tests, can give an early prognosis of an individual's ability to walk after traumatic @entity1566 , which can be used to set rehabilitation goals and might improve the ability to stratify @entity1 in interventional trials. FUNDING: Internationale Stiftung f  r Forschung in Paraplegie.
