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，全世界每年有25万到50万人 人们遭受脊髓损伤（SCI）。虽然现有的研究表明伤害事件之间的联系， 护理和康复结果，仍然存在一个关键的知识差距-关于如何特征 与创伤和SCI急性期相关的功能恢复可以让我们更好地了解SCI后的功能恢复， SCI.在过去，这项研究受到部分阻碍，因为数据库要么专注于创伤护理， 住院康复然而，利用先进的分析方法，我们现在能够将联合收割机 包含创伤和急性期相关变量以及患者水平特征的数据库， 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， 损伤原因、护理过程、临床数据和急性护理期间的结果数据。本报告的总体目标 本研究旨在利用创伤和急性期相关变量来解释患者的纵向功能恢复， SCI患者，从急性到急性后再到社区。这将通过概率链接来实现 宾夕法尼亚创伤系统结局研究（PTOS）数据库与国家脊髓损伤 模型系统（SCIMS）数据库。PTOS和SCIMS数据库提供了补充信息 从急性医院到住院康复机构（IRF）再到社区，对创伤和SCI急性期的认识。 我们研究的长期目标是确定可以利用的创伤和急性期相关变量 在急性护理和急性后康复干预期间， 加强康复计划。这项建议的中心假设是，创伤和急性期- 相关变量结合患者水平特征，将显著预测纵向功能 SCI后的恢复。我们的假设是由先前的研究和我们的试点工作与PTOS的指导 数据库本提案的主要目的是研究创伤与急性期之间的关系- 创伤性SCI患者使用机器进行IRF期间功能改善的相关变量 学习集成方法（目标1）。本研究的第二个目的是开发纵向轨迹 考虑到创伤、急性期和患者， 急性期、急性期后和社区生活期间的水平特征，使用生长曲线建模（目标2）。的 一项拟议的研究将对创伤和急性期相关疾病之间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.