• J Spinal Cord Med · Sep 2016

    Comparative Study

    International standards for neurological classification of spinal cord injury: impact of the revised worksheet (revision 02/13) on classification performance.

    • Christian Schuld, Steffen Franz, Karin Brüggemann, Laura Heutehaus, Norbert Weidner, Steven C Kirshblum, Rüdiger Rupp, and EMSCI study group.
    • a Heidelberg University Hospital, Spinal Cord Injury Center , Heidelberg , Germany.
    • J Spinal Cord Med. 2016 Sep 1; 39 (5): 504-12.

    Study DesignProspective cohort study.ObjectivesComparison of the classification performance between the worksheet revisions of 2011 and 2013 of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).SettingsOngoing ISNCSCI instructional courses of the European Multicenter Study on Human Spinal Cord Injury (EMSCI). For quality control all participants were requested to classify five ISNCSCI cases directly before (pre-test) and after (post-test) the workshop.ParticipantsOne hundred twenty-five clinicians working in 22 SCI centers attended the instructional course between November 2011 and March 2015. Seventy-two clinicians completed the post-test with the 2011 revision of the worksheet and 53 with the 2013 revision.InterventionsNot applicable.Outcome MeasuresThe clinicians' classification performance assessed by the percentage of correctly determined motor levels (ML) and sensory levels, neurological levels of injury (NLI), ASIA Impairment Scales and zones of partial preservations.ResultsWhile no group differences were found in the pre-tests, the overall performance (rev2011: 92.2% ± 6.7%, rev2013: 94.3% ± 7.7%; P = 0.010), the percentage of correct MLs (83.2% ± 14.5% vs. 88.1% ± 15.3%; P = 0.046) and NLIs (86.1% ± 16.7% vs. 90.9% ± 18.6%; P = 0.043) improved significantly in the post-tests. Detailed ML analysis revealed the largest benefit of the 2013 revision (50.0% vs. 67.0%) in a case with a high cervical injury (NLI C2).ConclusionThe results from the EMSCI ISNCSCI post-tests show a significantly better classification performance using the revised 2013 worksheet presumably due to the body-side based grouping of myotomes and dermatomes and their correct horizontal alignment. Even with these proven advantages of the new layout, the correct determination of MLs in the segments C2-C4 remains difficult.

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