Development and Validation of an Algorithm for Item Reduction of the International Standards for Neurological Classification of Spinal Cord Injury Examination to Determine Level and Severity of SCI.

In 2020, a first, expedited version of the International Standards for Neurological Classification of Spinal Cord Injury (E-ISNCSCI-V1) was proposed for determination of neurological level of injury (NLI) and American Spinal Injury Association Impairment Scale (AIS) classifications. This work descri...

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Publicado en:Topics in Spinal Cord Injury Rehabilitation Vol. 31; no. 3; pp. 61 - 68
Autores principales: Burns, Stephen P., Walden, Kristen, Kirshblum, Steven, Schmidt-Read, Mary, Tansey, Keith, Schuld, Christian, Rupp, Ruediger
Formato: research tables/charts Journal Article
Publicado: KnowledgeWorks Global, Ltd Summer2025
Acceso en línea:Ver este registro en EBSCOhost
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      dt: Summer2025
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      pub: KnowledgeWorks Global, Ltd
      place: Richmond, Virginia
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        atl: Development and Validation of an Algorithm for Item Reduction of the International Standards for Neurological Classification of Spinal Cord Injury Examination to Determine Level and Severity of SCI.
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        au:
          Burns, Stephen P.
          Walden, Kristen
          Kirshblum, Steven
          Schmidt-Read, Mary
          Tansey, Keith
          Schuld, Christian
          Rupp, Ruediger
        affil: Spinal Cord Injury Service, VA Puget Sound Health Care System, Seattle, Washington
      sug:
        subj:
          Algorithms
          Instrument Construction
          Instrument Validation
          Spinal Cord Injuries Diagnosis
          Severity of Injury Evaluation
          Neurologic Examination
          Reproducibility of Results
          Clinical Assessment Tools
          Human
          Funding Source
          Male
          Female
          Classification
          Validation Studies
          Sensitivity and Specificity
          Motor Neurons
          Perception
          Computer Simulation
          Retrospective Design
          Multicenter Studies
          Protocols
          Diagnostic Errors
          Adolescence
          Adult
          Middle Age
          Aged
          Aged, 80 and Over
          Adolescent: 13-18 years
          Adult: 19-44 years
          Middle Aged: 45-64 years
          Aged: 65+ years
          Aged, 80 & over
          Male
          Female
      ab: In 2020, a first, expedited version of the International Standards for Neurological Classification of Spinal Cord Injury (E-ISNCSCI-V1) was proposed for determination of neurological level of injury (NLI) and American Spinal Injury Association Impairment Scale (AIS) classifications. This work describes assessment of E-ISNCSCI-V1 classification accuracy and the development and data-based validation of an ISNCSCI Item Reduction Algorithm (IIRA). Classification accuracy for E-ISNCSCI-V1 examination shortcut options was assessed with automated analysis of 7026 full ISNCSCI examinations. Rules for the IIRA were iteratively adjusted to optimize the balance between omitting exam items and minimizing misclassification errors, and then it was validated through classification of 100 full ISNCSCI exams. If S1 findings are substituted for anorectal exam findings as proposed for E-ISNCSCI-V1, the error rate for AIS is 10%, with a high error rate (45%) for classifying true AIS B. The IIRA, which begins with full motor testing, followed by limited sensory testing required an average of 31% (42/134) of the full ISNCSCI exam items, with a 2% error rate for NLI and no AIS errors. The previously proposed E-ISNCSCI-V1, which included an option to substitute S1 findings for anorectal exam findings, is not recommended due to AIS error rate. The IIRA provides a standardized option for a shortened examination classifying NLI and AIS with high accuracy. It will serve as a basis for version 2 of the E-ISNCSCI.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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