Levine Gwendolyn J, Levine Jonathan M, Budke Christine M, Kerwin Sharon C, Au Jennifer, Vinayak Arathi, Hettlich Bianca F, Slater Margaret R
Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474, USA.
Prev Vet Med. 2009 May 1;89(1-2):121-7. doi: 10.1016/j.prevetmed.2009.02.016. Epub 2009 Mar 19.
The objectives of this study were to describe a new spinal cord injury scale for dogs, evaluate repeatability through determining inter-rater variability of scores, compare these scores to another established system (a modified Frankel scale), and determine if the modified Frankel scale and the newly developed scale were useful as prognostic indicators for return to ambulation. A group of client-owned dogs with spinal cord injury were examined by 2 independent observers who applied the new Texas Spinal Cord Injury Score (TSCIS) and a modified Frankel scale that has been used previously. The newly developed scale was designed to describe gait, postural reactions and nociception in each limb. Weighted kappa statistics were utilized to determine inter-rater variability for the modified Frankel scale and individual components of the TSCIS. Comparisons were made between raters for the overall TSCIS score and between scales using Spearman's rho. An additional group of dogs with surgically treated thoracolumbar disk herniation was enrolled to look at correlation of both scores with spinal cord signal characteristics on magnetic resonance imaging (MRI) and ambulatory outcome at discharge. The actual agreement between raters for the modified Frankel scale was 88%, with a weighted kappa value of 0.93. The TSCIS had weighted kappa scores for gait, proprioceptive positioning and nociception components that ranged from 0.72 to 0.94. Correlation between raters for the overall TSCIS score was Spearman's rho=0.99 (P<0.001). Comparison of the overall TSCIS score to the modified Frankel score resulted in a Spearman's rho value of 0.90 (P<0.001). The modified Frankel score was weakly correlated with the length of hyperintensity of the spinal cord: L2 vertebral body length ratio on mid-sagittal T2-weighted MRI (Spearman's rho=-0.45, P=0.042) as was the overall TSCIS score (Spearman's rho=-0.47, P=0.037). There was also a significant difference in admitting modified Frankel scores (P=0.029) and admitting overall TSCIS scores (P=0.02) between dogs that were ambulatory at discharge and those that were not. Results from this study suggest that the TSCIS is an easy to administer scale for evaluating canine spinal cord injury based on the standard neurological exam and correlates well with a previously described modified Frankel scale.
本研究的目的是描述一种用于犬的新脊髓损伤量表，通过确定评分者间分数的变异性来评估可重复性，将这些分数与另一个既定系统（改良的Frankel量表）进行比较，并确定改良的Frankel量表和新开发的量表是否可用作恢复行走的预后指标。一组脊髓损伤的客户拥有的犬由2名独立观察者进行检查，他们应用了新的德克萨斯脊髓损伤评分（TSCIS）和先前使用过的改良Frankel量表。新开发的量表旨在描述每个肢体的步态、姿势反应和伤害感受。加权kappa统计用于确定改良Frankel量表和TSCIS各个组成部分的评分者间变异性。使用Spearman秩相关系数在评分者之间对TSCIS总分进行比较，并在量表之间进行比较。另外纳入一组接受手术治疗的胸腰椎间盘突出症犬，以观察两个量表评分与磁共振成像（MRI）上脊髓信号特征以及出院时行走结果的相关性。改良Frankel量表评分者之间的实际一致性为88%，加权kappa值为0.93。TSCIS的步态、本体感觉定位和伤害感受组成部分的加权kappa评分范围为0.72至0.94。TSCIS总分评分者之间的相关性为Spearman秩相关系数=0.99（P<0.001）。将TSCIS总分与改良Frankel评分进行比较，Spearman秩相关系数值为0.90（P<0.001）。改良Frankel评分与脊髓高信号长度：矢状面T2加权MRI上L2椎体长度比值弱相关（Spearman秩相关系数=-0.45，P=0.042），TSCIS总分也是如此（Spearman秩相关系数=-0.47，P=0.037）。出院时能行走的犬与不能行走的犬在入院时的改良Frankel评分（P=0.029）和入院时的TSCIS总分（P=0.02）也存在显著差异。本研究结果表明，TSCIS是一种基于标准神经学检查评估犬脊髓损伤的易于实施的量表，并且与先前描述的改良Frankel量表相关性良好。
