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The development and internal validation of a model to predict functional recovery after trauma

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  • Max W de Graaf
  • Inge H F Reininga
  • Erik Heineman
  • Mostafa El Moumni

Abstract

Objective: To develop and internally validate the PROgnosis of functional recovery after Trauma (PRO-Trauma) prediction model. Design: A prospective single-center longitudinal cohort study. Patients were assessed at 6 weeks and 12 months post-injury. Methods: Patients that presented at the emergency department with an acute traumatic injury, were prompted for participation. Patients that completed the assessments at 6 weeks and 12 months post injury were included. Exclusion criteria: age 65, pathologic fractures, injuries that resulted in severe neurologic deficits. The predicted outcome, functional recovery, was defined as a Short Musculoskeletal Function Assessment (SMFA-NL) Problems with Daily Activities (PDA) subscale ≤ 12.2 points at 12 months post-injury (Dutch population norm). Predictors were: gender, age, living with partner, number of chronic health conditions, SMFA-NL PDA score 6 weeks post-injury, ICU admission, length of stay in hospital, injury severity score, occurrence of complications and treatment type. All predictors were obtained before 6 weeks post-injury. Missing data were multiply imputed. Predictor variables were selected using backward stepwise multivariable logistic regression. Hosmer-Lemeshow tests were used to evaluate calibration. Bootstrap resampling was used to internally validate the final model. Results: A total of 246 patients were included, of which 104 (44%) showed functional recovery. The predictors in the final PRO-Trauma model were: living with partner, the number of chronic health conditions, SMFA-NL PDA subscale score at 6 weeks post-injury and length of stay in hospital. The apparent R2 was 0.33 [0.33;0.34], the c-statistic was 0.79 [0.79;0.80]. Hosmer-Lemeshow test indicated good calibration (p = 0.92). Optimism-corrected R2 was 0.28 [0.27;0.29] and the optimism-corrected Area Under the Curve was 0.77 [0.77;0.77]. Conclusion: The PRO-Trauma prediction model can be used to obtain valid predictions of attaining functional recovery after trauma at 12 months post-injury. The PRO-Trauma prediction model showed acceptable calibration and discrimination.

Suggested Citation

  • Max W de Graaf & Inge H F Reininga & Erik Heineman & Mostafa El Moumni, 2019. "The development and internal validation of a model to predict functional recovery after trauma," PLOS ONE, Public Library of Science, vol. 14(3), pages 1-16, March.
    • Handle: RePEc:plo:pone00:0213510
    DOI: 10.1371/journal.pone.0213510
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    1. Nancy Devlin;John Appleby, 2010. "Getting the Most out of PROMs: Putting Health Outcomes at the Heart of NHS Decision-Making," Monograph 000220, Office of Health Economics.
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