DEVELOPING A PROGNOSTIC NOMOGRAM FOR PEDIATRIC ATHLETES WITH SPINAL CORD INJURIES: INSIGHTS FROM A RETROSPECTIVE, MULTICENTER OBSERVATIONAL STUDY

Abstract

Background: There is a critical need for prognostic tools that can accurately predict outcomes for pediatric athletes experiencing spinal cord injuries. This study aims to develop and validate a prognostic nomogram that forecasts the 3-, 5-, and 7-year outcomes based on initial injury assessments. Methods: We included pediatric patients diagnosed with spinal cord injuries from January 2014 to December 2021 at our subcenter, focusing on those incurred during athletic activities. Prognosis was determined using the American Spinal Injury Association (ASIA) Impairment Scale, with improvement defined as a higher ASIA score at follow-up compared to admission. Data from 50% of the patients were used as a training set for the nomogram, with the remaining serving as the validation set. Variables for the nomogram, such as spinal fracture presence, surgical interventions, initial ASIA and Functional Independence Measure (FIM) scores, and the ratio of the length of abnormal signal on MRI to spinal height, were identified using Cox proportional hazards modeling. Results: A total of 79 pediatric patients with spinal cord injuries were analyzed, with a median follow-up of 42.0 months. Multivariate Cox regression highlighted independent protective factors such as spinal fracture, surgery, and initial ASIA and FIM scores, and a risk factor was the abnormal signal length/spinal height ratio. The nomogram exhibited excellent predictive accuracy, with a corrected C-index of 0.93 in the training set and 0.84 (95% CI: 0.71 to 0.93) in the validation set. Calibration plots confirmed the nomogram's reliability in predicting actual improvement in ASIA scores. Conclusions: The validated nomogram offers a precise, reliable tool for forecasting long-term recovery prospects in pediatric athletes with spinal cord injuries, using initial injury severity and treatment interventions. This tool aids healthcare providers in creating tailored rehabilitation and treatment plans, potentially enhancing recovery trajectories and athletic career outcomes for young athletes.