International standards for neurological classification of spinal cord injury: training effect on accurate classification.
OBJECTIVE
To evaluate the accuracy and agreement of International Standards for Neurological Classification of Spinal Cord Injury (ISCSCI) classification and to determine the effectiveness of formal training for pediatric clinicians.


METHODS
Participants (N = 28) in a formal 90-minute classification training session.


METHODS
Pre/post-training examination of 10 case examples of a variety of neurological classifications.


RESULTS
Regardless of years of experience with the ISCSCI, a statistically significant improvement (P < 0.05) in classification was achieved after formal training. Before training, 27% (539 of 1,960) of the questions were answered incorrectly. After training, the percentage of incorrect classifications decreased to 11% (198 of 1,960) incorrect (P < 0.05). After training, the percentage of incorrect motor level classifications decreased by 23% (42% to 19% incorrect; P< 0.05). Post-training improvements were also demonstrated (P< 0.05) in classifying sensory levels (9% to 3% incorrect), neurological levels (31% to 6% incorrect), and severity of injury (9% to 0% incorrect). After training, reductions in classification errors (P < 0.05) were demonstrated in American Spinal Injury Association (ASIA) Impairment Scale (AIS) A (from 20% to 7%), B (50% to 11%), C (71% to 46%), and D (63% to 16%).


CONCLUSIONS
This study demonstrated the benefits of formal, standardized training for accurate classification of the ISCSCI. Effective training programs must emphasize the guidelines and decision algorithms used to determine motor level and ASIA AIS designations because these remained problematic after training and are often a concern of patients/parents and are primary endpoints in clinical trials for neurological recovery.
Chafetz
Ross S
RS
Shriners Hospitals for Children, Philadelphia, Pennsylvania 19140, USA.
Vogel
Lawrence C
LC
Betz
Randal R
RR
Gaughan
John P
JP
Mulcahey
Mary Jane
MJ
D004185:Disability Evaluation; D004521:Educational Measurement; D006801:Humans; D009460:Neurologic Examination / Q000592:standards*; D009462:Neurology / Q000193:education*; D013119:Spinal Cord Injuries / Q000145:classification* / Q000175:diagnosis*