Prediction of early bladder outcomes after spinal cord injury: The HALT score

Abstract

AimsNeurogenic bladder (NB) is a prevalent and debilitating consequence of spinal cord injury (SCI). Indeed, the accurate prognostication of early bladder outcomes is crucial for patient counseling, rehabilitation goal setting, and personalized intervention planning.MethodsA retrospective exploratory analysis was conducted on a cohort of consecutive SCI patients admitted to a rehabilitation facility in China from May 2016 to December 2022. Demographic, clinical, and electrophysiological data were collected within 40 days post‐SCI, with bladder outcomes assessed at 3 months following SCI onset.ResultsThe present study enrolled 202 SCI patients with a mean age of 40.3 ± 12.3 years. At 3 months post‐SCI, 79 participants exhibited complete bladder emptying. Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analyses identified the H‐reflex of the soleus muscle, the American Spinal Injury Association Lower Extremity Motor Score (ASIA‐LEMS), and the time from lesion to rehabilitation facility (TLRF) as significant independent predictors for bladder emptying. A scoring system named HALT was developed, yielding a strong discriminatory performance with an area under the receiver operating characteristics curve (aROC) of 0.878 (95% CI: 0.823–0.933). A simplified model utilizing only the H‐reflex exhibited excellent discriminatory ability with an aROC of 0.824 (95% CI: 0.766–0.881). Both models demonstrated good calibration via the Hosmer–Lemeshow test and favorable clinical net benefits through decision curve analysis (DCA). In comparison to ASIA‐LEMS, both the HALT score and H‐reflex showed superior predictive accuracy for bladder outcome. Notably, in individuals with incomplete injuries, the HALT score (aROC = 0.973, 95% CI: 0.940–1.000) and the H‐reflex (aROC = 0.888, 95% CI: 0.807–0.970) displayed enhanced performance.ConclusionTwo reliable models, the HALT score and the H‐reflex, were developed to predict bladder outcomes as early as 3 months after SCI onset. Importantly, this study provides hitherto undocumented evidence regarding the predictive significance of the soleus H‐reflex in relation to bladder outcomes in SCI patients.