Document Detail


Effect of formal training in scaling, scoring and classification of the International Standards for Neurological Classification of Spinal Cord Injury.
MedLine Citation:
PMID:  23184026     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: Prospective, longitudinal cohort study.
OBJECTIVES: To quantify the effect of formal training in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) on the classification accuracy and to identify the most difficult ISNCSCI rules.
SETTINGS: European Multicenter Study on Human Spinal Cord Injury (EMSCI).
METHODS: EMSCI participants rated five challenging cases of full sensory, motor and anorectal examinations before (pre-test) and after (post-test) an ISNCSCI instructional course. Classification variables included sensory and motor levels (ML), completeness, ASIA Impairment Scale (AIS) and the zones of partial preservation.
RESULTS: 106 attendees were trained in 10 ISNCSCI workshops since 2006. The number of correct classifications increased significantly (P<0.00001) from 49.6% (2628 of 5300) in pre-testing to 91.5% (4849 of 5300) in post-testing. Every attendee improved, 12 (11.3%) achieved 100% correctness. Sensory levels (96.8%) and completeness (96.2%) are easiest to rate in post-testing, while ML (81.9%) and AIS (88.1%) are more difficult to determine. Most of the errors in ML determination arise from sensory levels in the high cervical region (C2-C4), where by convention the ML is presumed to be the same as the sensory level. The most difficult step in AIS classification is the determination of motor incompleteness.
CONCLUSION: ISNCSCI training significantly improves the classification skills regardless of the experience in spinal cord injury medicine. These findings need to be considered for the appropriate preparation and interpretation of clinical trials in spinal cord injury.
Authors:
C Schuld; J Wiese; S Franz; C Putz; I Stierle; I Smoor; N Weidner; ; R Rupp
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-11-27
Journal Detail:
Title:  Spinal cord     Volume:  51     ISSN:  1476-5624     ISO Abbreviation:  Spinal Cord     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-05     Completed Date:  2013-09-30     Revised Date:  2014-07-31    
Medline Journal Info:
Nlm Unique ID:  9609749     Medline TA:  Spinal Cord     Country:  England    
Other Details:
Languages:  eng     Pagination:  282-8     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Cohort Studies
Disability Evaluation*
Factor Analysis, Statistical
Health Personnel / education*
Humans
Nervous System Diseases / classification*,  diagnosis*,  etiology
Neurologic Examination / methods,  standards*
Questionnaires
Retrospective Studies
Spinal Cord Injuries / complications

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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