eprintid: 26482
rev_number: 10
eprint_status: archive
userid: 1589
dir: disk0/00/02/64/82
datestamp: 2019-05-29 12:23:36
lastmod: 2024-02-29 06:34:50
status_changed: 2019-05-29 12:23:36
type: article
metadata_visibility: show
creators_name: Hug, Andreas
creators_name: Schuld, Christian
creators_name: Mürle, Bettina
creators_name: Böttinger, Markus
creators_name: Weidner, Norbert
creators_name: Rupp, Rüdiger
title: Ulnar nerve integrity predicts 1-year outcome in cervical spinal cord injury
subjects: ddc-610
divisions: i-910100
abstract: Background: Accurate predictors of neurological recovery after cervical spinal cord injury are needed. Particularly, to tailor adequate rehabilitation plans. However, objective and quantifiable predictors are sparse. 
  
Methods: Within the prospective European Multicenter Study about Spinal Cord Injury (EMSCI) registry, cervical spinal cord injury patients are monitored at fixed follow up visits (2, 4, 12, 24, and 48 weeks after injury) clinically and with ulnar nerve electroneurography. Associations of ulnar nerve compound muscle action potential amplitudes (CMAP) with American Spinal Cord Injury Association (ASIA) impairment scale (AIS) grades over time were analyzed using linear mixed modeling. Applying logistic regression, the prognostic value of within 4-week ulnar nerve CMAP for 1-year AIS was analyzed. To account for missing data, (1) last observation carried forward and (2) multiple imputation methods were applied. For model derivation, our centers’ cohort (EMSCI-HD) was analyzed. For model validation the cohort of other centers (EMSCI-nonHD) was used.

Results: In the EMSCI-HD cohort, the median age (interquartile range (IQR)) was 52 (34–67) years. 58% were male. The initial AIS distribution was: A = 31%, B = 17%, C = 30%, and D = 22%). In the EMSCI-nonHD cohort, the median age was 49 (32–65) years. Compared to the EMSCI-HD cohort more patients were male (79%, p = 0.0034). The AIS distribution was: A = 33%, B = 13%, C = 21%, and D = 33%). In complete-case mixed model analyses (EMSCI-HD: n = 114; EMSCI-nonHD: n = 508) higher ulnar nerve CMAP were associated with better AIS grades over the entire follow up period. In complete-case logistic regression (EMSCI-HD: n = 90; EMSCI-nonHD: n = 444) higher ulnar nerve CMAP was an independent predictor of better AIS grades. The odds ratio for within 4-week ulnar nerve CMAP to predict 1-year AIS grade D versus A-C in the EMSCI-HD cohort was 1.24 per millivolt (confidence interval 1.07–1.44). The model was validated in an independent cervical spinal cord injury (EMSCI-nonHD) cohort (odds ratio 1.09, confidence interval 1.03–1.17).  

Conclusions: In cervical spinal cord injury, the consideration of early ulnar nerve CMAP improves prognostic accuracy, which is of particular importance in patients with clinical grading uncertainties.
date: 2019
publisher: BioMed Central
id_scheme: DOI
ppn_swb: 1669541568
own_urn: urn:nbn:de:bsz:16-heidok-264828
language: eng
bibsort: HUGANDREASULNARNERVE2019
full_text_status: public
publication: Neurological research and practice
volume: 1
number: 11
place_of_pub: [London]
pagerange: 1-8
issn: 2524-3489
citation:   Hug, Andreas ; Schuld, Christian ; Mürle, Bettina ; Böttinger, Markus ; Weidner, Norbert ; Rupp, Rüdiger  (2019) Ulnar nerve integrity predicts 1-year outcome in cervical spinal cord injury.  Neurological research and practice, 1 (11).  pp. 1-8.  ISSN 2524-3489     
document_url: https://archiv.ub.uni-heidelberg.de/volltextserver/26482/1/42466_2019_Article_17.pdf