Guidelines for neuroprognostication in adults with traumatic spinal cord injury

Neurocrit Care, 2024 · DOI: https://doi.org/10.1007/s12028-023-01845-8 · Published: November 13, 2023

Spinal Cord Injury Critical Care Research Methodology & Design

Simple Explanation

These guidelines address the ability of clinicians to share prognostic information about mortality and functional outcomes with adult patients who have suffered a traumatic spinal cord injury (tSCI). This information enables patients and their families to engage in decision-making and plan for the future. The guidelines categorize predictors of outcomes as reliable, moderately reliable, or not reliable, based on the certainty of evidence and the accuracy of the predictor. The good practice recommendations emphasize considering the complete clinical condition of the patient and communicating both the challenges of functional deficits and the potential for improvement.

Study Duration

Not specified

Participants

Adults with traumatic spinal cord injury

Evidence Level

Narrative systematic review using GRADE methodology

Key Findings

1
Pathologic findings on magnetic resonance imaging (MRI), neurological level of injury, and severity of injury are moderately reliable predictors of American Spinal Cord Injury Impairment Scale (AIS) improvement.
2
The Dutch Clinical Prediction Rule is a moderately reliable prediction model of independent ambulation at 1 year after injury.
3
No other reliable or moderately reliable predictors of mortality or functional outcome were identified.

Research Summary

These guidelines provide recommendations about the reliability of acute-phase predictors of mortality, functional outcome, American Spinal Injury Association Impairment Scale grade conversion, and recovery of independent ambulation for consideration when counseling patients with tSCI or their surrogates and suggest broad principles of neuroprognostication in this context. Three predictors (absence of pathologic findings on MRI, NLI, and injury severity) were considered moderately reliable for the prediction of AIS conversion at 1-year follow-up. A clinical prediction model, the DCPR, was considered moderately reliable for the prediction of independent ambulation at 1-year follow-up.

Practical Implications

Informed Decision-Making

Provides clinicians with evidence-based recommendations to aid in counseling patients and families about likely outcomes, supporting shared decision-making.

Realistic Expectations

Helps patients and families set realistic expectations and plan for long-term care by offering prognostic information regarding potential recovery or adaptation.

Targeted Rehabilitation

Enables clinicians to better focus rehabilitation efforts, whether on return of function or adaptation, based on accurate prognostication.

Study Limitations

1
Heterogeneity in injury patterns and management strategies
2
Poor quality of overall literature on tSCI outcomes
3
Most studies performed retrospective analysis of registry databases that may exclude important variables

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