Clinical prediction of functional and neurological outcomes in spinal cord injury: A scoping review.

CONTEXT: Spinal cord injury (SCI) significantly impacts quality of life, imposing considerable healthcare burdens. Accurate prediction of functional and neurological recovery is critical but remains challenging due to the condition's complexity.

OBJECTIVE

This scoping review aims to comprehensively synthesize current evidence on predicting functional and neurological outcomes after adult SCI, identifying prognostic factors, evaluating existing prediction models, and highlighting areas for future research.

METHODS

A systematic search of Embase, MEDLINE, CINAHL, and Cochrane was conducted for studies published after 2005 involving prognostic indicators in adult SCI. Inclusion criteria focused on longitudinal studies examining clinical, radiological, and neurophysiological predictors of functional or neurological recovery, explicitly excluding progressive SCI and mortality prediction.

RESULTS

Seventy-one studies met the inclusion criteria, identifying initial injury severity, age at injury, and presence of sensorimotor sparing as key predictors. Validated clinical prediction rules (CPRs) predominantly focused on ambulation, notably the Dutch CPRs, though their predictive accuracy was reduced for moderately severe injuries (AIS grades B and C). Upper limb and bladder/bowel outcomes were less studied. Prognostic accuracy improved significantly when integrating neurophysiological measures (e.g. motor evoked potentials) with clinical assessments.

CONCLUSIONS

Initial severity, sensorimotor sparing, and age at injury are significant prognostic indicators post-SCI. Current prediction tools are effective primarily for ambulation outcomes but less reliable for moderate injuries. Future research should prioritize comprehensive models incorporating clinical, neurophysiological, and radiological predictors to enhance individualized prognostication, particularly in cases of incomplete SCI.