脊髓损伤神经学分类国际标准：修订工作表（02/13 修订版）对分类性能的影响
International standards for neurological classification of spinal cord injury: impact of the revised worksheet (revision 02/13) on classification performance.
作者信息
Schuld Christian, Franz Steffen, Brüggemann Karin, Heutehaus Laura, Weidner Norbert, Kirshblum Steven C, Rupp Rüdiger
机构信息
a Heidelberg University Hospital, Spinal Cord Injury Center , Heidelberg , Germany.
b Kessler Institute for Rehabilitation , West Orange , NJ , USA.
出版信息
J Spinal Cord Med. 2016 Sep;39(5):504-12. doi: 10.1080/10790268.2016.1180831. Epub 2016 Jun 14.
STUDY DESIGN
Prospective cohort study.
OBJECTIVES
Comparison of the classification performance between the worksheet revisions of 2011 and 2013 of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).
SETTINGS
Ongoing 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.
PARTICIPANTS
One 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.
INTERVENTIONS
Not applicable.
OUTCOME MEASURES
The 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.
RESULTS
While 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).
CONCLUSION
The 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.
研究设计
前瞻性队列研究。
目的
比较《脊髓损伤神经学分类国际标准》（ISNCSCI）2011年和2013年工作表修订版的分类性能。
背景
欧洲人类脊髓损伤多中心研究（EMSCI）正在进行的ISNCSCI教学课程。为进行质量控制，要求所有参与者在研讨会之前（预测试）和之后（后测试）直接对5例ISNCSCI病例进行分类。
参与者
2011年11月至2015年3月期间，22个脊髓损伤中心的125名临床医生参加了该教学课程。72名临床医生完成了2011年工作表修订版的后测试，53名完成了2013年修订版的后测试。
干预措施
不适用。
观察指标
通过正确确定运动水平（ML）和感觉水平、损伤神经水平（NLI）、美国脊髓损伤协会损伤分级以及部分保留区域的百分比来评估临床医生的分类性能。
结果
虽然在预测试中未发现组间差异，但在后测试中，总体性能（rev2011：92.2%±6.7%，rev2013：94.3%±7.7%；P=0.010）、正确ML的百分比（83.2%±14.5%对88.1%±15.3%；P=0.046）和NLI（86.1%±16.7%对90.9%±18.6%；P=0.043）均有显著改善。详细的ML分析显示，在高位颈髓损伤（NLI C2）病例中，2013年修订版的益处最大（50.0%对67.0%）。
结论
EMSCI的ISNCSCI后测试结果表明，使用2013年修订版工作表的分类性能明显更好，这可能是由于基于身体侧的肌节和皮节分组及其正确的水平对齐。即使新布局有这些已证实的优势，C2-C4节段ML的正确确定仍然困难。
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