Predicting Low and Non-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 Classification of SCI), Spinal Cord Independence Measure (SCIM), and Walking Index for SCI (WISCI). Rehabilitation results were measured by treatment effectiveness, reflecting the proportion 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 the mean plus one SD. Forward stepwise logistic 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 that year of admission, older age, and complications at admission and during rehabilitation were independently associated with reduced likelihood of high SCIM response; complications at admission and during rehabilitation were associated with reduced likelihood of high WISCI response; year of admission, older age, longer lesion-to-admission time, and complications during rehabilitation predicted prolonged LOS; and more recent year of admission, traumatic etiology, and lower discharge SCIM were associated with nursing home placement. Conclusions: Our data provide a basis for further research into the problem of SCI prognosis. Subgroups of subjects with poor or excellent rehabilitation prognosis could be recognized at the beginning of treatment based on clinical factors.