Prediction of Bladder Outcomes after Traumatic Spinal Cord Injury: A Longitudinal Cohort Study

PLoS Medicine, 2016 · DOI: 10.1371/journal.pmed.1002041 · Published: June 21, 2016

Spinal Cord Injury Urology Research Methodology & Design

Simple Explanation

This study aimed to create a tool to predict bladder control after a traumatic spinal cord injury. The researchers analyzed data from 1,250 patients and validated their prediction models on an independent group of 111 patients. The models use factors like leg strength and sensation to estimate the likelihood of regaining bladder continence and complete emptying one year after the injury.

Study Duration

1 Year

Participants

1,250 patients with traumatic SCI for model derivation, 111 for external validation

Evidence Level

Longitudinal Cohort Study

Key Findings

1
Two prediction models were developed: a full model using LEMS, light-touch sensation in the S3 dermatome, and SCIM subscale respiration and sphincter management; and a simplified model based on LEMS only.
2
The full model had an area under the receiver operating characteristics curve (aROC) of 0.936, while the simplified model had an aROC of 0.912.
3
External validation confirmed the excellent predictive power of both models, with aROCs of 0.965 and 0.972 for the full and simplified models, respectively.

Research Summary

The study developed and validated two models to predict urinary continence and complete bladder emptying 1 year after traumatic SCI using data from a large European multicenter study. The models, one full and one simplified, rely on neurological and functional assessments performed within 40 days of the injury. Both models showed excellent predictive power in both the derivation and validation cohorts, suggesting their potential for clinical application in early counseling and patient-tailored interventions.

Practical Implications

Early Prediction

The models allow for early prediction of bladder outcomes, crucial for patient counseling and setting realistic rehabilitation goals.

Patient Stratification

The models can improve patient stratification in future clinical trials assessing treatments for bladder dysfunction in SCI.

Individualized Urological Management

The models can help identify patients who might benefit from specific rehabilitative interventions, such as neuromodulative procedures.

Study Limitations

1
The study is limited by the substantial number of patients with a missing 1-y outcome.
2
Differences between derivation and validation cohort.
3
The effect of treatment on bladder outcomes was not assessed.

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