Achieving assessor accuracy on the International Standards for Neurological Classification of Spinal Cord Injury

Armstrong, Alex; Clark, Jillian; Ho, Diwei; Payne, Cathy; Nolan, S; Goodes, Louise M; Harvey, L A; Marshall, Ruth; Galea, Mary P.; Dunlop, Sarah

doi:10.1038/sc.2017.67

Cited by 19 publications

(26 citation statements)

References 28 publications

(59 reference statements)

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“…Due to insufficient documentation (e.g. missing ISNCSCI/AIS charts), together with evidence for systematic inaccuracies in manually completed ISNCSCI worksheets, 73 we were unable to reliably stratify neurological condition, so a binary variable for presence of SCI (neurological deficit vs. no neurological deficit) was assigned to each patient. Dichotomisation of these data allows for the assessment of the spectrum of neurological involvement, but introduces assumptions in relation to injury heterogeneity.…”

Section: Direct Radiographic Measurements Of Spinal Canal Occlusion Amentioning

confidence: 99%

Traumatic subaxial cervical facet subluxation and dislocation: epidemiology, radiographic analyses, and risk factors for spinal cord injury

et al. 2018

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Section: Direct Radiographic Measurements Of Spinal Canal Occlusion Amentioning

confidence: 99%

Traumatic subaxial cervical facet subluxation and dislocation: epidemiology, radiographic analyses, and risk factors for spinal cord injury

et al. 2018

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“…The accuracy rate of the completed components in the study was 78.1%. In earlier studies that evaluated fully documented ISNCSCI charts only, the pre-training accuracy of clinicians ranged from 25.5 to 73% [3, 16, 17]. On evaluating the completed entries only, the least accurate components were motor levels (36.8%) and sensory levels (43.5%).…”

Section: Discussionmentioning

confidence: 99%

“…The American Spinal Injury Association (ASIA) and International Spinal Cord Society (ISCoS) International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is the international communication tool used to determine the severity and level of the injury in patients with spinal cord injuries (SCI) [1–3]. The ISNCSCI involves a physical examination and the documentation of total motor and sensory scores, motor and sensory levels as well as a single neurological level of injury, an ASIA Impairment Scale, and severity of injury (complete/incomplete) [2, 4].…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have shown that medical records by junior doctors were incomplete and lacked essential data on physical examination of the patients [12–15]. Previous studies conducted in the artificial settings of ISNCSCI training courses and clinical trials have revealed challenges in achieving accuracy in the completion of ISNCSCI charts [2, 3, 16, 17]. To our knowledge, no study has evaluated ISNCSCI chart completion and accuracy of documentation in a busy day-to-day clinical setting.…”

Section: Introductionmentioning

confidence: 99%

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International Standards for Neurological Classification of Spinal Cord Injury: factors influencing the frequency, completion and accuracy of documentation of neurology for patients with traumatic spinal cord injuries

Osunronbi

Sharma

2019

Eur J Orthop Surg Traumatol

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IntroductionWe aim to evaluate the effects of injury-related factors and clinician training grades on the frequency, completion and accuracy of International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) charts in a tertiary care neurosurgery unit.Materials and methodsWe retrospectively analysed 96 ISNCSCI charts of 24 traumatic spinal cord-injured (SCI) patients and 26 controls (vertebral fracture but neurologically intact), written by 50 clinicians. Seven components of each ISNCSCI charts (motor scores, sensory scores, sensory levels, motor levels, neurological level of injury, SCI severity and AIS) were reviewed to evaluate the effect of injury factors and clinician grade on the completion and accuracy of the ISNCSCI components.ResultsThe ISNCSCI chart was used 1.9 times on average during admission. The number of ISNCSCI assessments was significant in those with isolated spinal injuries (p = 0.03). The overall completion and accuracy rates of the assessed ISNCSCI chart components were 39% and 78.1%, respectively. Motor levels and AIS had the lowest completion rates. Motor levels and sensory levels had the lowest accuracy rates. The completion rate was higher in the charts of male patients, tetraplegic patients, and in patients with isolated spinal injuries. The junior clinicians had a significantly greater ISNCSCI chart completion rate than their seniors. However, the senior clinicians were more accurate in completing the ISNCSCI chart components.ConclusionThe quality of ISNCSCI documentation remained poor regardless of the clinician training grade and injury factors. Clinicians should be educated on the ISNCSCI protocol and the importance of adequate documentation.Electronic supplementary materialThe online version of this article (10.1007/s00590-019-02502-7) contains supplementary material, which is available to authorized users.

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“…To ensure a correct determination of all ISNCSCI variables, two essential skill sets are required: (1) a reliable and valid clinical examination and (2) an accurate classification of the examination results. Referring to the latter, several articles have been published, showing the relevance of standardized training to achieve high classification accuracy [7][8][9]. In contrast, evidence on the importance of attaining detailed knowledge of the challenges and requirements of an accurate ISNCSCI examination is still sparse and less comprehensive [10].…”

Section: Introductionmentioning

confidence: 99%

Theoretical and practical training improves knowledge of the examination guidelines of the International Standards for Neurological Classification of Spinal Cord Injury

et al. 2020

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Study design Prospective pre–post study. Objectives International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) represents the most frequently used assessment to determine the level and severity of a spinal cord injury (SCI). The guidelines for ISNCSCI are complex and challenging. Knowledge of its correct execution needs to be imparted precisely. The aim of this study was to investigate whether hands-on instructional courses can increase the knowledge of the ISNCSCI examination guidelines. Setting European Multicenter Study about SCI. Methods Before and after the instructional courses, participants were asked to complete questionnaires. The set of questions covered the most important aspects of the examination guidelines. Attendees were asked to self-rate their occupation and experience in ISNCSCI. Results The comparison of pretest and posttest results of 164 attendees from 2014 to 2018 revealed an improvement of knowledge reflected by an increase of correct answers from 66 ± 17% before to 89 ± 11% after the course (p < 0.01). The improvement was not associated with occupation (p > 0.1). However, the correctness of pretest results differed concerning both the period of experience with ISNCSCI (p < 0.05) and the course language (p < 0.01), while the frequency of execution resulted in differences in the posttest (p = 0.01). Conclusions Instructional courses substantially improve knowledge of the ISNCSCI examination guidelines. Differences in knowledge present before the course leveled off after the course. Comprehensive theoretical training is strongly recommended to ensure reliability and validity of ISNCSCI examinations in clinical routine and research. Albeit being practiced in the instructional courses, the benefit of hands-on training still needs to be systematically evaluated in future studies.

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Achieving assessor accuracy on the International Standards for Neurological Classification of Spinal Cord Injury

Abstract: Given inaccuracies in the manual ISNCSCI worksheets in this long-term clinical trial setting, continued training and a computerised algorithm are essential to ensure accurate scoring, scaling and classification of the ISNCSCI and confidence in clinical trials.

Cited by 19 publications

References 28 publications

Traumatic subaxial cervical facet subluxation and dislocation: epidemiology, radiographic analyses, and risk factors for spinal cord injury

Traumatic subaxial cervical facet subluxation and dislocation: epidemiology, radiographic analyses, and risk factors for spinal cord injury

International Standards for Neurological Classification of Spinal Cord Injury: factors influencing the frequency, completion and accuracy of documentation of neurology for patients with traumatic spinal cord injuries

Theoretical and practical training improves knowledge of the examination guidelines of the International Standards for Neurological Classification of Spinal Cord Injury

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