Schuld C, Franz S, van Hedel H J A, Moosburger J, Maier D, Abel R, van de Meent H, Curt A, Weidner N, Rupp R
Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany.
1] Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland [2] Rehabilitation Center for Children and Juveniles, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.
Spinal Cord. 2015 Apr;53(4):324-31. doi: 10.1038/sc.2014.221. Epub 2014 Dec 9.
This is a retrospective analysis.
The objective of this study was to describe and quantify the discrepancy in the classification of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) by clinicians versus a validated computational algorithm.
European Multicenter Study on Human Spinal Cord Injury (EMSCI).
Fully documented ISNCSCI data sets from EMSCI's first years (2003-2005) classified by clinicians (mostly spinal cord medicine residents, who received in-house ISNCSCI training by senior SCI physicians) were computationally reclassified. Any differences in the scoring of sensory and motor levels, American Spinal Injury Association Impairment Scale (AIS) or the zone of partial preservation (ZPP) were quantified.
Four hundred and twenty ISNCSCI data sets were evaluated. The lowest agreement was found in motor levels (right: 62.1%, P=0.002; left: 61.8%, P=0.003), followed by motor ZPP (right: 81.6%, P=0.74; left 80.0%, P=0.27) and then AIS (83.4%, P=0.001). Sensory levels and sensory ZPP showed the best concordance (right sensory level: 90.8%, P=0.66; left sensory level: 90.0%, P=0.30; right sensory ZPP: 91.0%, P=0.18; left sensory ZPP: 92.2%, P=0.03). AIS B was most often misinterpreted as AIS C and vice versa (AIS B as C: 29.4% and AIS C as B: 38.6%).
Most difficult classification tasks were the correct determination of motor levels and the differentiation between AIS B and AIS C/D. These issues should be addressed in upcoming ISNCSCI revisions. Training is strongly recommended to improve classification skills for clinical practice, as well as for clinical investigators conducting spinal cord studies.
This study is partially funded by the International Foundation for Research in Paraplegia, Zurich, Switzerland.
这是一项回顾性分析。
本研究的目的是描述并量化临床医生与经过验证的计算算法在脊髓损伤神经学分类国际标准（ISNCSCI）分类方面的差异。
欧洲人类脊髓损伤多中心研究（EMSCI）。
对EMSCI最初几年（2003 - 2005年）由临床医生（主要是脊髓医学住院医师，他们接受了资深脊髓损伤医生的内部ISNCSCI培训）分类的完整记录的ISNCSCI数据集进行计算重新分类。对感觉和运动水平评分、美国脊髓损伤协会损伤量表（AIS）或部分保留区（ZPP）的任何差异进行量化。
评估了420个ISNCSCI数据集。运动水平的一致性最低（右侧：62.1%，P = 0.002；左侧：61.8%，P = 0.003），其次是运动ZPP（右侧：81.6%，P = 0.74；左侧80.0%，P = 0.27），然后是AIS（83.4%，P = 0.001）。感觉水平和感觉ZPP显示出最佳的一致性（右侧感觉水平：90.8%，P = 0.66；左侧感觉水平：90.0%，P = 0.30；右侧感觉ZPP：91.0%，P = 0.18；左侧感觉ZPP：92.2%，P = 0.03）。AIS B最常被误判为AIS C，反之亦然（AIS B误判为C：29.4%，AIS C误判为B：38.6%）。
最困难的分类任务是正确确定运动水平以及区分AIS B和AIS C/D。这些问题应在即将到来的ISNCSCI修订中得到解决。强烈建议进行培训，以提高临床实践以及开展脊髓研究的临床研究人员的分类技能。
本研究部分由瑞士苏黎世截瘫研究国际基金会资助。
