Problems and solutions associated with the clinical application of the international standards for neurological classification of spinal cord injury

English Keywords:Spinal cord injury  American spinal injury association  Neurological classification  Impairment scale

English Abstract:

  【Abstract】 Objectiveｓ： To find practice-based problems of the application of international standards for neurological classification of ｓｐｉｎａｌ　ｃｏｒｄ　ｉｎｊｕｒｙ(ISNCSCI, ASIA standard), and to search the solutions. Methodｓ： The clinical materials including all medical text records and images of 341 SCI cases（in 2010）, which were classified by using ISNCSCI in the hospital, were obtained. The original injury level, motor level as well as ASIA impairment scale(AIS) of each patient were extracted from the medical text records by junior doctors and reassessed by senior doctors according to the obtained clinical materials. Lastly, for all cases, the oringinally given classification and the reassessment results were compaired and analysed. Resultｓ： Concerning AIS, there were 178 oringinal A patients, 1 and 2 of whom were reassessed as B and C respectively; there were 1 and 15 of 43 oringinal B to A and C; and 2 of 34 oringinal C to 1 B and 1 D. The rest 45 cases were with unknown scale. 15 C were oringinally identified as B because the patients with 1 or 2 levels motor function preserved at more than three levels below the motor level were primarily considered as B, but not C. Misclassifications of 1 B and 2 C to A were caused by simply reviewing the ASIA sheets and ignorence of the notes of non-key muscle power and anal deep sensory in the medical text records. The mistakes of 1 A to B, 1 B to C and 1 D to C could be explained as just counting errors. As for injury level, no inaccuracy was found in 139 cervical cases, 145 thoracic cases, 21 conus medullaris syndrome(CMS) cases, 12 cauda equina syndrome(CES) cases，and 7 unknow level cases. 12 and 4 of oringinal 17 lumbar SCI cases were modified by the senior doctors to be CMS and CES, respectively. This problem was brought by the confusion of neural injury range among L1-5, CMS and CES. In addition, 18 of 22 patients who sustained central cord syndrome had muscles power of grade ２ to　５ in lower extremities, were originally recognized to have motor levels at cervical segments by misunderstanding of the concept of motor level. Conclusionｓ：　A precise and intensive comprehension of the wording in ASIA standard is strongly suggested since it is just the solution to address the abovementioned clinical problems.