Article

OBJECTIVES: To quantify the
effect of formal training in the International Standards for Neurological
Classification of Spinal Cord Injury (ISNCSCI) on the classification accuracy and
to identify the most difficult ISNCSCI rules.Settings:European Multicenter Study
on Human Spinal Cord Injury (EMSCI). METHODS : EMSCI participants rated five
challenging cases of full sensory, motor and anorectal examinations before
(pre-test) and after (post-test) an ISNCSCI instructional course. Classification
variables included sensory and motor levels (ML), completeness, ASIA Impairment
Scale (AIS) and the zones of partial preservation. RESULTS: 106 attendees were
trained in 10 ISNCSCI workshops since 2006. The number of correct classifications
increased significantly (P<0.00001) from 49.6% (2628 of 5300) in pre-testing to
91.5% (4849 of 5300) in post-testing. Every attendee improved, 12 (11.3%)
achieved 100% correctness. Sensory levels (96.8%) and completeness (96.2%) are
easiest to rate in post-testing, while ML (81.9%) and AIS (88.1%) are more
difficult to determine. Most of the errors in ML determination arise from sensory
levels in the high cervical region (C2-C4), where by convention the ML is
presumed to be the same as the sensory level. The most difficult step in AIS
classification is the determination of motor incompleteness. CONCLUSION: ISNCSCI
training significantly improves the classification skills regardless of the
experience in spinal cord injury medicine. These findings need to be considered
for the appropriate preparation and interpretation of clinical trials in spinal
cord injury.

Langue : ANGLAIS