An Evaluation of International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) Performance Within the Canadian SCI Network.
Heather A Hong, Jessica Parsons, Jijie Xu and 22 others
PMID 40873963WHAT IT FOUND
Most spinal cord injury exams in this Canadian registry were done within a week, but nearly half were incomplete.
Missing sensory and rectal tests led to significantly higher classification errors compared to full exams, risking inaccurate diagnosis and prognosis.
Key findings
01Overall, 70% of participants had an examination performed, with 76% of those completed within 72 hours and 91% within 7 days.
02Nearly half of the examinations were partially completed, with sensory scores and rectal items being the most frequently absent components.
03Partial examinations had significantly higher mismatch rates for neurological level (28%) and ASIA Impairment Scale (19%) classification compared to full examinations.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was conducted within a specific registry network (RHSCIR) that provides training and encourages early exams, so performance in facilities without these supports may be worse. Nontraumatic spinal cord injury cohorts were smaller than traumatic injury cohorts, which may bias comparisons between the two groups. The study is retrospective and relies on documented data; reasons for missing exams were often unknown or not documented.
Declared interests
The authors declare no conflicts of interest. However, one author serves on the ASIA International Standards Committee, and several are employees of the Praxis Spinal Cord Institute.
The easy way to misread this
Do not assume that a documented ASIA Impairment Scale score is accurate if the exam was partial. The study shows that missing rectal and sensory items leads to high mismatch rates in classification, meaning the recorded severity of the injury may be wrong.