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Development of Predictive Algorithms for Pre-Treatment Motor Deficit and 90-Day Mortality in Spinal Epidural Abscess

Shah, Akash A., BS1; Ogink, Paul T., MD1; Harris, Mitchel B., MD1; Schwab, Joseph H., MD, MS1,a

doi: 10.2106/JBJS.17.00630
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Background: Spinal epidural abscess is a high-risk condition that can lead to paralysis or death. It would be of clinical and prognostic utility to identify which subset of patients with spinal epidural abscess is likely to develop a motor deficit or die within 90 days of discharge.

Methods: We identified all patients ≥18 years of age who were admitted to our hospital system with a diagnosis of spinal epidural abscess during the period of 1993 to 2016. Explanatory variables were collected retrospectively. Bivariate and multivariable logistic regression was performed using these variables to identify independent predictors of motor deficit and 90-day mortality. Nomograms were then constructed to quantify the risk of these outcomes.

Results: Of the 1,053 patients we identified with spinal epidural abscess, 362 presented with motor weakness. One hundred and thirty-four patients died within 90 days of discharge, inclusive of those who died during hospitalization. Multivariable logistic regression yielded 8 independent predictors of pre-treatment motor deficit and 8 independent predictors of 90-day mortality. We constructed nomograms that generated a probability of pre-treatment motor deficit or 90-day mortality on the basis of the presence of these factors.

Conclusions: By quantifying the risk of pre-treatment motor deficit and 90-day mortality, our nomograms may provide useful prognostic information for the treatment team. Timely treatment of neurologically intact patients with a high risk of developing a motor deficit is necessary to avoid residual motor weakness and improve survival.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of Levels of Evidence.

1Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts

aE-mail address for J.H. Schwab: jhschwab@mgh.harvard.edu

Copyright © 2018 by The Journal of Bone and Joint Surgery, Incorporated
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