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Classification and regression tree (CART) model to assist clinical prediction for tracheostomy in patients with traumatic cervical spinal cord injury: a 7-year study of 340 patients

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Abstract

Objective

To develop a classification and regression tree (CART) model to predict the need of tracheostomy in patients with traumatic cervical spinal cord injury (TCSCI) and to quantify scores of risk factors to make individualized clinical assessments.

Methods

The clinical characteristics of patients with TCSCI admitted to our hospital from January 2014 to December 2020 were retrospectively analyzed. The demographic characteristics (gender, age, smoking history), mechanism of injury, injury characteristics (ASIA impairment grades, neurological level of impairment, injury severity score), preexisting lung disease and preexisting medical conditions were statistically analyzed. The risk factors of tracheostomy were analyzed by univariate logistic regression analysis (ULRA) and multiple logistic regression analysis (MLRA). The CART model was established to predict tracheostomy.

Results

Three hundred and forty patients with TCSCI met the inclusion criteria, in which 41 patients underwent the tracheostomy. ULRA and MLRA showed that age > 50, ISS > 16, NLI > C5 and AIS A were significantly associated with tracheostomy. The CART model showed that AIS A and NLI > C5 were at the first and second decision node, which had a significant influence on the decision of tracheostomy. The final scores for tracheostomy from CART algorithm, composed of age, ISS, NLI and AIS A with a sensitivity of 0.78 and a specificity of 0.96, could also predict tracheostomy.

Conclusion

The establishment of CART model provided a certain clinical guidance for the prediction of tracheostomy in TCSCI. Quantifications of risk factors enable accurate prediction of individual patient risk of need for tracheostomy.

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Authors and Affiliations

  1. Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, 183 Xinqiao Street, Shapingba District, Chongqing, 400037, China

    Dawei Sun & Zhengfeng Zhang

  2. The Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, China

    Hanqing Zhao

Authors
  1. Dawei Sun
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  2. Hanqing Zhao
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  3. Zhengfeng Zhang
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Contributions

DS: Investigation, Data statistics, Writing. HZ: Data collection, Data statistics. ZZ: Conceptualization; Writing-review & editing.

Corresponding authors

Correspondence to Hanqing Zhao or Zhengfeng Zhang.

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Data availability

The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

All procedures used in this research were approved by the Ethics Committee of Army Medical University.

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Cite this article

Sun, D., Zhao, H. & Zhang, Z. Classification and regression tree (CART) model to assist clinical prediction for tracheostomy in patients with traumatic cervical spinal cord injury: a 7-year study of 340 patients. Eur Spine J 31, 1283–1290 (2022). https://doi.org/10.1007/s00586-022-07154-6

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  • DOI: https://doi.org/10.1007/s00586-022-07154-6

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