Predicting No and Low Responders and Outliers in Patients with Spinal Cord Injury

Background Patients with spinal cord injury (SCI) typically have longer lengths of stay (LOS) compared to other rehabilitation patients and show variable therapeutic responses. Identifying reliable predictors of functional outcomes is essential. This study aimed to find prognostic factors to detect patients with high/low functional response, prolonged LOS, and those discharged home. Methods We retrospectively reviewed charts of SCI patients admitted to our center since 1997, recording neurological status (International Standards for Neurological Classifica-tion of SCI), Spinal Cord Independence Measure (SCIM), and Walking Index for SCI (WIS-CI). Rehabilitation results were measured by treatment effectiveness, reflecting the propor-tion of potential improvement achieved. Patients with SCIM and WISCI effectiveness above the mean plus one standard deviation (SD) were considered outliers, as were those with LOS exceeding mean plus one SD. Forward stepwise multiple regression identified variables linked to high effectiveness, LOS, and discharge destination. Results A total of 1059 patients were included (739 males, mean age 50.8±18; 587 with non-traumatic etiology). There were 132 LOS outliers, 163 high SCIM responders, and 144 high WISCI responders; 913 were discharged home. Regression analysis found age, lesion level, and complications at admission and during rehabilitation predicted SCIM outliers; AIS grade, age, and rehabilitation complications predicted WISCI outliers; rehabilitation complications, discharge SCIM, bladder management independence, and lesion etiology were linked to longer LOS; discharge SCIM, fecal incontinence, and gender influenced home discharge. Conclusions Our data provide a basis for further research into the problem of SCI progno-sis. Subgroups of subjects with poor or excellent rehabilitation prognosis could be recog-nized at the beginning of treatment based on clinical factors.