title: Interrater reliability of the international standards for neurological classification of spinal cord injury in youths with chronic spinal cord injury.
abstract: OBJECTIVE
  To evaluate the interrater reliability of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) in children with chronic spinal cord injury (SCI), and to define the lower age limit at which the examinations have clinical utility.
  
  
  METHODS
  Repeated measures, multicenter reliability study.
  
  
  METHODS
  Two U.S. pediatric specialty hospitals with recognized SCI programs.
  
  
  METHODS
  Children (N=236) with chronic SCI.
  
  
  METHODS
  Subjects underwent 4 examinations by 2 raters: sensory tests (pin prick [PP] and light touch [LT]), a motor test, and a test of anal sensation (AS) and anal contraction (AC).
  
  
  METHODS
  A 2-way general linear model analysis of variance was used for analysis. Intraclass correlation coefficients (ICCs) and 95% confidence intervals were calculated for PP, LT, motor, AS, and AC.
  
  
  RESULTS
  No child younger than 6 years completed the examination. When examined as a function of age, interrater reliability for motor, PP, LT, AS, and AC was moderate (ICC=.89) to high (ICC=.99). There was poor reliability for AS (ICC=.49) in subjects with complete injuries but moderate reliability for all other variables. There was moderate to high reliability for classification of type (tetraplegia/paraplegia) and severity (complete/incomplete) of injury across age groups.
  
  
  CONCLUSIONS
  The ISNCSCI does not have utility for children younger than 6 years. For children older than 6 years, interrater reliability of PP, LT, and motor examinations is high.
authors.affiliation: Shriners Hospitals for Children, 3551 N. Broad Street, Philadelphia, PA 19140, USA. mmulcahey@shrinenet.org
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Mulcahey
authors.forename: John P
authors.initials: JP
authors.lastname: Gaughan
authors.forename: Ross S
authors.initials: RS
authors.lastname: Chafetz
authors.forename: Larry C
authors.initials: LC
authors.lastname: Vogel
authors.forename: Amer F
authors.initials: AF
authors.lastname: Samdani
authors.forename: Randal R
authors.initials: RR
authors.lastname: Betz
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002908:Chronic Disease; D016001:Confidence Intervals; D004185:Disability Evaluation; D019988:Children with Disabilities / Q000145:classification*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D016014:Linear Models; D008297:Male; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000145:classification*; D014481:United States; D055815:Young Adult