Early Trauma Predictors of Mobility in People With Spinal Cord Injury

Einat Engel-Haber, MD; Irina Radomislensky, BSc; Kobi Peleg, PhD, MPH; Moran Bodas, PhD, MPH; Israel Trauma Group; Moshe Bondi, MD; Shlomo Noy, MD, PhD; Gabi Zeilig, MD


Spine. 2021;46(20):E1089-E1096. 

In This Article

Abstract and Introduction


Study Design: A retrospective cohort study.

Objective: This study aims to assess the potential value of very early trauma variables such as Abbreviated Injury Scale (AIS) and the Injury Severity Score for predicting independent ambulation following a traumatic spinal cord injury (TSCI).

Summary of Background Data: Several models for prediction of ambulation early after TSCI have been published and validated. The vast majority rely on the initial examination of American Spinal Injury Association (ASIA) impairment scale and level of injury; however, in many locations and clinical situations this examination is not feasible early after the injury.

Methods: Patient characteristics, trauma data, and ASIA scores on admission to rehabilitation were collected for each of the 144 individuals in the study. Outcome measure was the indoor mobility item of the Spinal Cord Independence Measure taken upon discharge from rehabilitation. Univariate and multivariable models were created for each predictor, Odds ratios (ORs) were obtained by a multivariable logistic regression analysis, and area under the receiver operator curve was calculated for each model.

Results: We observed a significant correlation between the trauma variables and independent ambulation upon discharge from rehabilitation. Of the early variables, the AIS for the spine region showed the strongest correlation.

Conclusion: These findings support using preliminary trauma variables for early prognostication of ambulation following a TSCI, allowing for tailored individual interventions.

Level of Evidence: 3


Given the severe consequences of traumatic spinal cord injury (TSCI), the burden both on individual and societal level, and the escalating health-care costs, it is important to collect and store high-quality data, including clinical, functional and social information. Across the world, data are stored in designated spinal cord injury (SCI) registries from the time of the acute hospitalization and throughout the rehabilitation period.[1–3] Frequently, data collection continues for many years following discharge from the hospital.[1] Most often, the initial evaluation and treatment of TSCIs occur within the hospital's trauma system and data regarding this period are sometimes contained in separate trauma registries.[4,5] Linking early trauma and acute hospitalization data with rehabilitation data enables the creation of an all-inclusive registry and supports extensive high-quality research.

The Model Trauma System Planning and Evaluation document, released by the Health Resources and Service Administration in 2006, recognizes the role of trauma systems not only in reducing mortality but also in the successful integration of trauma survivors back into society through rehabilitation medicine.[6] Although in the past a greater focus was placed on short-term hospital-based outcomes such as mortality and morbidity, today there is an emerging shift in focus to long-term community-based outcomes.[7]

Following an injury, an early and reliable prognosis of a patient's potential functional outcome is essential for counseling and for designing a personalized acute and rehabilitation programs. For example, in a recent study, Evaniew et al discussed the need of accurate prediction of long-term outcomes in the acute settings, within hours of a TSCI; although it may be seen as too ambitious, very early prediction is important in the era of modern clinical trials of neuroprotective interventions that are administered as soon as possible (i.e., 24 hours) following the injury.[8]

The past decades have seen a shift in the focus of neurorehabilitation from the use of compensatory approaches to neurorecovery, that is, restoration of function through use of the affected limbs by activity-dependent neural adaptation and training.[9–11] This shift has been most apparent in the rehabilitation of individuals with incomplete SCI.[10] Therefore, early detection and prognostication of individuals that may be candidates for restorative treatments, are crucial.

Several researchers have studied the relationship between parameters from the initial assessment at the onset of trauma and functional outcomes, mostly with regards to multi-trauma or traumatic brain injury (TBI).[12–15] Fewer papers discussed the relationship between early trauma variables and outcomes of a TSCI: Nemunaitis et al[16] examined the correlation between Injury Severity Score (ISS)[17] and the Functional Independence Measure (FIM)[18] score, Stephan et al[19] showed an association between the Abbreviated Injury Scale (AIS)[20] and the Glasgow Outcome Scale (GOS) grade.

Due to the nature of TSCI, much focus is given to prognostication of ambulation, that is, who will be able to walk independently following the injury. Several clinical prediction rules for prediction of independent ambulation have been established;[21–24] however, these rules include variables that are usually collected on a later stage and not available early after the trauma in most cases.

This study was set to explore the relationship between trauma severity and independent mobility of people with TSCI as measured by the Spinal Cord Independence Measure (SCIM).[25]