Hong Heather A, Parsons Jessica, Xu Jijie, Walden Kristen, Fallah Nader, Cheng Christiana L, Attabib Najmedden, Christie Sean D, Craven B Catharine, Fehlings Michael G, Fourney Daryl R, Ho Chester, Julien Lisa, Kwon Brian K, Linassi Gary A, Loyola-Sanchez Adalberto, Moganathas Saranjan, Paquet Jerome, Sreenivasan Vidya, Mac-Thiong Jean-Marc, Townson Andrea, Tsai Eve C, Urquhart Jennifer, Whelan Alexander, Noonan Vanessa K
Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada.
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Top Spinal Cord Inj Rehabil. 2025 Summer;31(3):15-36. doi: 10.46292/sci25-00011. Epub 2025 Aug 22.
To describe the performance of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination in individuals with traumatic spinal cord injury (TSCI) and nontraumatic spinal cord injury (NTSCI) across Canadian acute and rehabilitation facilities, evaluating timing, completeness, and classification accuracy.
Using the Rick Hansen Spinal Cord Injury Registry (2015-2022), participants were analyzed across 6 cohorts: (A) TSCI-acute-admission ( = 4461), (B) TSCI-acute-discharge ( = 972), (C) TSCI-rehabilitation-admission ( = 2673), (D) TSCI-rehabilitation-discharge = 2316), (E) NTSCI-rehabilitation-admission ( = 728), and (F) NTSCI-rehabilitation-discharge = 619). ISNCSCI data included performed (yes/no), timing (≤72 hours, ≤7 days, and >7 days of admission/discharge), completeness, missing items, and worksheet used (yes/no). Classification accuracy between the clinician-determined and algorithm-generated ASIA Impairment Scale and neurological level of injury classification was evaluated. Descriptive and bivariate statistics were used to analyze cohorts.
Overall, 70% of participants had at least one examination performed, with 76% performed ≤72 hours, 91% ≤7 days, and 9% >7 days. However, 45% were partially complete, primarily missing sensory scores and rectal components ≤7 days. Comparison of TSCI and NTSCI during rehabilitation showed that NTSCI cohorts had significantly more exams at admission and fewer at discharge, with more complete exams. Moreover, age at injury, injury type, mechanism, severity, length of stay, and pain influenced examination performance.
This study highlights the need for greater consistency in ISNCSCI examination performance and identifies patient-level barriers to completion. Determining the most effective standardized approach for ISNCSCI use across SCI care, addressing modifiable human/organizational factors, and ensuring comprehensive clinical training will improve the quality of this assessment.
描述国际脊髓损伤神经分类标准（ISNCSCI）检查在加拿大急性和康复机构中创伤性脊髓损伤（TSCI）和非创伤性脊髓损伤（NTSCI）患者中的执行情况，评估检查时间、完整性和分类准确性。
利用里克·汉森脊髓损伤登记处（2015 - 2022年）的数据，对6个队列的参与者进行分析：（A）TSCI - 急性入院（n = 4461），（B）TSCI - 急性出院（n = 972），（C）TSCI - 康复入院（n = 2673），（D）TSCI - 康复出院（n = 2316），（E）NTSCI - 康复入院（n = 728），以及（F）NTSCI - 康复出院（n = 619）。ISNCSCI数据包括是否进行检查（是/否）、时间（入院/出院≤72小时、≤7天和>7天）、完整性、缺失项目以及所使用的工作表（是/否）。评估临床医生确定的和算法生成的ASIA损伤量表及神经损伤水平分类之间的分类准确性。采用描述性和双变量统计分析各队列。
总体而言，70%的参与者至少接受了一次检查，其中76%在≤72小时内进行检查，91%在≤7天内进行检查，9%在>7天进行检查。然而，45%的检查部分完成，主要是在≤7天内缺失感觉评分和直肠部分。对TSCI和NTSCI在康复期间的比较显示，NTSCI队列在入院时检查更多，出院时检查更少，但检查更完整。此外，受伤年龄、损伤类型、机制、严重程度、住院时间和疼痛会影响检查表现。
本研究强调了在ISNCSCI检查执行方面需要更大的一致性，并确定了完成检查的患者层面障碍。确定在脊髓损伤护理中使用ISNCSCI的最有效标准化方法，解决可改变的人为/组织因素，并确保全面的临床培训将提高该评估的质量。
