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Development and validation of a nomogram for predicting the prognosis in children with spinal cord injuries

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Abstract

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.

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Author notes

  1. Bo Wang and Liukun Xu have contributed equally to this study.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China

    Bo Wang, Liukun Xu, Pengfei Zheng & Zhiqun Zhang

  2. Anhui Province Children’s Hospital, Hefei City, 230051, Anhui Province, China

    Yapeng Zhang

  3. The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, 310009, Zhejiang Province, China

    Wangmi Liu

  4. Zhongda Hospital, Southeast University, Nanjing City, 210000, Jiangsu Province, China

    Yuntao Wang

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  1. Bo Wang
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  2. Liukun Xu
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  4. Yapeng Zhang
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Correspondence to Zhiqun Zhang.

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Wang, B., Xu, L., Zheng, P. et al. Development and validation of a nomogram for predicting the prognosis in children with spinal cord injuries. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08208-7

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  • DOI: https://doi.org/10.1007/s00586-024-08208-7

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