Evaluating associations between trauma-related characteristics and functional recovery in individuals with spinal cord injury

项目摘要 世界卫生组织确定，每年在世界各地，有25万到50万 人们遭受脊髓损伤(SCI)。虽然现有的研究表明伤害事件之间存在联系，但早期 在护理和康复结果方面，仍然存在严重的知识差距--关于特征 与创伤和急性期相关的脊髓损伤可以使我们更好地了解脊髓损伤后的功能恢复。 SCI。在过去，这项研究在一定程度上受到了阻碍，因为数据库要么专注于创伤护理，要么 住院康复。然而，使用先进的分析方法，我们现在能够结合 包含创伤和急性期相关变量的数据库，这些变量具有患者级别的特征以进行评估 随着时间的推移，纵向功能恢复。创伤和急性期相关变量包括创伤类型， 急性护理期间的受伤原因、护理过程、临床数据和结果数据。这样做的总体目标是 研究目的是用创伤和急性期相关变量来解释患者的纵向功能恢复。 脊髓损伤的个体，从急性到急性后急性到社区。这将通过概率链接来实现 宾夕法尼亚州创伤系统结果研究(PTOS)数据库和国家脊髓损伤 模型系统(SCIMS)数据库。PTOS和SCIMS数据库提供免费信息 从急诊医院到住院康复机构(IRF)再到社区，了解SCI的创伤和急性期。 我们研究的长期目标是确定可以利用的创伤和急性时相相关变量 在急性护理和急性后康复干预期间，以改善临床决策，进而 加强康复计划。这项提议的中心假设是创伤和急性期- 相关变量，结合患者水平的特征，将显著预测纵向功能 脊髓损伤后个体的康复。我们的假设是由先前的研究和我们与PTO的试点工作所指导的 数据库。这项建议的一个主要目标是研究创伤和急性期之间的联系。 机械治疗创伤性脊髓损伤患者IRF期间功能改善的相关变量 学习集成方法(目标1)。这项研究的次要目标是开发纵向轨迹 包括创伤、急性期和患者在内的脊髓损伤后1年的功能恢复情况。 使用生长曲线模型研究急性、急性后和社区生活的水平特征(目标2)。这个 拟议的研究将对创伤和急性期相关的关系产生新的见解 具有功能状态的变量。

Project Summary World Health Organization established that every year, around the world, between 250,000 and 500,000 people suffer a spinal cord injury (SCI). While existing research suggests links between the injury event, early care, and rehabilitation outcomes, there still remains a critical knowledge gap – about how characteristics associated with trauma and acute phases of SCI can allow us to better understand functional recovery post- SCI. In the past, this research was partly hampered due to databases that either focused on trauma-care or inpatient rehabilitation. However, using advanced analytical methods, we are now in a position to combine databases that contain trauma and acute phase-related variables with patient-level characteristics to assess longitudinal functional recovery over time. Trauma and acute phase-related variables include type of trauma, cause of injury, process of care, clinical data, and outcome data during acute care. The overall objective of this study is to use trauma and acute phase-related variables to explain the longitudinal functional recovery of individuals with SCI, from acute to post-acute to community. This will be achieved by probabilistically linking the Pennsylvania Trauma Systems Outcomes Study (PTOS) database with the National Spinal Cord Injury Model Systems (SCIMS) database. The PTOS and SCIMS databases provide complimentary information about trauma and acute phases of SCI from acute hospital to inpatient rehabilitation facility (IRF) to community. The long-term goal of our research is to identify trauma and acute phase-related variables that can be utilized during acute care and post-acute rehabilitation interventions to improve clinical decision making, which in turn enhances rehabilitation programs.The central hypothesis of this proposal is that trauma and acute phase- related variables, combined with patient-level characteristics, will significantly predict longitudinal functional recovery in individuals post-SCI. Our hypothesis is guided by prior research and our pilot work with the PTOS database. A primary objective of this proposal is to examine the association between trauma and acute phase- related variables with functional improvements during IRF in individuals with traumatic SCI using machine learning ensemble methods (Aim 1). A secondary objective of this study is to develop longitudinal trajectories of functional recovery over a period of 1-year post-SCI taking into account trauma, acute phase, and patient- level characteristics during acute, post-acute, and community living using growth curve modelling (Aim 2). The proposed study will yield novel insights about the relationship between trauma and acute phase-related variables with functional status.