1
|
Yuan W, Sun J, Li Q, Zheng R, Guan B, Chen Z, Ding J, Sun Q, Fu R, Wang W, Fan Y, Kang Y, Sun C, Li A, Wu D, Wang D, Qi L, Chen L, Feng S, Zhou H. Protocol for the Chinese Real-World Evidence for Acute Spinal Cord Injury (ChiRES) study: a prospective, observational, multicentre cohort study of acute spinal cord injury. BMJ Open 2024; 14:e080358. [PMID: 38749680 PMCID: PMC11097860 DOI: 10.1136/bmjopen-2023-080358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/30/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) is a catastrophic event with devastating physical, social and occupational consequences for patients and their families. The number of patients with acute SCI in China continues to grow rapidly, but there have been no large prospective cohort studies of patients with acute SCI. This proposed study aims to establish a multicentre, extensive sample cohort of clinical data and biological samples of patients in China, which would aid the systematisation and standardisation of clinical research and treatment of acute SCI, thus reducing the heavy burden of acute SCI on patients and society. METHODS AND ANALYSIS The Chinese Real-World Evidence for Acute Spinal Cord Injury (ChiRES) study is an observational, multicentre cohort study of patients with acute SCI admitted to the Qilu Hospital of Shandong University and other participating centres with prospective collection of their clinical data and biological samples. We aim to recruit 2097 patients in this study. Demographics, disease history, emergency intervention information, motor and sensory examinations, surgical information, medication information and rehabilitation evaluation will be recorded. This will facilitate the development of a prediction model for complications and prognosis of patients with acute SCI and an evaluation of the current management of acute SCI. Among these variables, detailed information on surgical treatment will also be used to assess procedures for acute SCI treatment. Outcome measurements, including the International Standard for Neurological Classification of Spinal Cord Injury examinations, the occurrence of complications and death, will be performed repeatedly during follow-up. We will analyse imaging data and blood samples to develop SCI imaging markers and biomarkers. ETHICS AND DISSEMINATION This study protocol has been approved by the Medical Ethics Committee of the Qilu Hospital of Shandong University and all other participating centres. The findings will be disseminated in peer-reviewed journals and academic conferences.
Collapse
Affiliation(s)
- Wenjian Yuan
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jiuxiao Sun
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Qingyang Li
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ruiyuan Zheng
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Bin Guan
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zhuo Chen
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jiaming Ding
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Qingyu Sun
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Runhan Fu
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Wei Wang
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yuxuan Fan
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin Medical University, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, China
| | - Yi Kang
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin Medical University, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, China
| | - Chao Sun
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin Medical University, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, China
| | - Ang Li
- Department of Orthopaedics, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Dongjin Wu
- The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Dachuan Wang
- The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Lei Qi
- The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Lingxiao Chen
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Sydney Musculoskeletal Health, The Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Shiqing Feng
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin Medical University, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, China
- The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Hengxing Zhou
- Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China
| |
Collapse
|
2
|
Wu X, Xi X, Xu M, Gao M, Liang Y, Sun M, Hu X, Mao L, Liu X, Zhao C, Sun X, Yuan H. Prediction of early bladder outcomes after spinal cord injury: The HALT score. CNS Neurosci Ther 2024; 30:e14628. [PMID: 38421138 PMCID: PMC10850821 DOI: 10.1111/cns.14628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 03/02/2024] Open
Abstract
AIMS Neurogenic bladder (NB) is a prevalent and debilitating consequence of spinal cord injury (SCI). Indeed, the accurate prognostication of early bladder outcomes is crucial for patient counseling, rehabilitation goal setting, and personalized intervention planning. METHODS A retrospective exploratory analysis was conducted on a cohort of consecutive SCI patients admitted to a rehabilitation facility in China from May 2016 to December 2022. Demographic, clinical, and electrophysiological data were collected within 40 days post-SCI, with bladder outcomes assessed at 3 months following SCI onset. RESULTS The present study enrolled 202 SCI patients with a mean age of 40.3 ± 12.3 years. At 3 months post-SCI, 79 participants exhibited complete bladder emptying. Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analyses identified the H-reflex of the soleus muscle, the American Spinal Injury Association Lower Extremity Motor Score (ASIA-LEMS), and the time from lesion to rehabilitation facility (TLRF) as significant independent predictors for bladder emptying. A scoring system named HALT was developed, yielding a strong discriminatory performance with an area under the receiver operating characteristics curve (aROC) of 0.878 (95% CI: 0.823-0.933). A simplified model utilizing only the H-reflex exhibited excellent discriminatory ability with an aROC of 0.824 (95% CI: 0.766-0.881). Both models demonstrated good calibration via the Hosmer-Lemeshow test and favorable clinical net benefits through decision curve analysis (DCA). In comparison to ASIA-LEMS, both the HALT score and H-reflex showed superior predictive accuracy for bladder outcome. Notably, in individuals with incomplete injuries, the HALT score (aROC = 0.973, 95% CI: 0.940-1.000) and the H-reflex (aROC = 0.888, 95% CI: 0.807-0.970) displayed enhanced performance. CONCLUSION Two reliable models, the HALT score and the H-reflex, were developed to predict bladder outcomes as early as 3 months after SCI onset. Importantly, this study provides hitherto undocumented evidence regarding the predictive significance of the soleus H-reflex in relation to bladder outcomes in SCI patients.
Collapse
Affiliation(s)
- Xiangbo Wu
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Xiao Xi
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Mulan Xu
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
- Department of Rehabilitation Medicine, Shenshan Medical Center, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityShanweiGuangdongChina
| | - Ming Gao
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Ying Liang
- Department of Health StatisticsAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Miaoqiao Sun
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Xu Hu
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Li Mao
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Xingkai Liu
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Chenguang Zhao
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Xiaolong Sun
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| | - Hua Yuan
- Department of Rehabilitation Medicine, Xijing HospitalAir Force Medical University (Fourth Military Medical University)Xi'anChina
| |
Collapse
|
4
|
Lucci G, Pisotta I, Berchicci M, Di Russo F, Bonavita J, Scivoletto G, Spinelli D, Molinari M. Proactive Cortical Control in Spinal Cord Injury Subjects with Paraplegia. J Neurotrauma 2019; 36:3347-3355. [DOI: 10.1089/neu.2018.6307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giuliana Lucci
- Electrophysiology of Cognition Lab and Fondazione Santa Lucia IRCCS, Rome, Italy
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
| | - Iolanda Pisotta
- SPInal REhabilitation Lab–SPIRE, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Marika Berchicci
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico,” Rome, Italy
| | - Francesco Di Russo
- Electrophysiology of Cognition Lab and Fondazione Santa Lucia IRCCS, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico,” Rome, Italy
| | - Jacopo Bonavita
- Spinal Unit, Montecatone Rehabilitation Institute, Imola (Bologna), Italy
| | - Giorgio Scivoletto
- SPInal REhabilitation Lab–SPIRE, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Donatella Spinelli
- Electrophysiology of Cognition Lab and Fondazione Santa Lucia IRCCS, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico,” Rome, Italy
| | - Marco Molinari
- SPInal REhabilitation Lab–SPIRE, Fondazione Santa Lucia IRCCS, Rome, Italy
| |
Collapse
|