Development and validation of a computerized algorithm for International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).
METHODS
Validation study.


OBJECTIVE
To describe the development and validation of a computerized application of the international standards for neurological classification of spinal cord injury (ISNCSCI).


METHODS
Data from acute and rehabilitation care.


METHODS
The Rick Hansen Institute-ISNCSCI Algorithm (RHI-ISNCSCI Algorithm) was developed based on the 2011 version of the ISNCSCI and the 2013 version of the worksheet. International experts developed the design and logic with a focus on usability and features to standardize the correct classification of challenging cases. A five-phased process was used to develop and validate the algorithm. Discrepancies between the clinician-derived and algorithm-calculated results were reconciled.


RESULTS
Phase one of the validation used 48 cases to develop the logic. Phase three used these and 15 additional cases for further logic development to classify cases with 'Not testable' values. For logic testing in phases two and four, 351 and 1998 cases from the Rick Hansen SCI Registry (RHSCIR), respectively, were used. Of 23 and 286 discrepant cases identified in phases two and four, 2 and 6 cases resulted in changes to the algorithm. Cross-validation of the algorithm in phase five using 108 new RHSCIR cases did not identify the need for any further changes, as all discrepancies were due to clinician errors. The web-based application and the algorithm code are freely available at www.isncscialgorithm.com.


CONCLUSIONS
The RHI-ISNCSCI Algorithm provides a standardized method to accurately derive the level and severity of SCI from the raw data of the ISNCSCI examination. The web interface assists in maximizing usability while minimizing the impact of human error in classifying SCI.


BACKGROUND
This study is sponsored by the Rick Hansen Institute and supported by funding from Health Canada and Western Economic Diversification Canada.
Rick Hansen Institute, Vancouver, British Columbia, Canada.
K
K
Walden
Rick Hansen Institute, Vancouver, British Columbia, Canada.|Vancouver Spine Program, Vancouver General Hospital, Vancouver, British Columbia, Canada.
L M
LM
Bélanger
Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Havnevej, Hornbaek, Denmark.
F
F
Biering-Sørensen
Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
S P
SP
Burns
Rick Hansen Institute, Vancouver, British Columbia, Canada.
E
E
Echeverria
Kessler Institute for Rehabilitation, Rutgers New Jersey Medical School, West Orange, NJ, USA.
S
S
Kirshblum
Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
R J
RJ
Marino
Rick Hansen Institute, Vancouver, British Columbia, Canada.|Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada.
V K
VK
Noonan
Rick Hansen Institute, Vancouver, British Columbia, Canada.
S E
SE
Park
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
R K
RK
Reeves
Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA.
W
W
Waring
Vancouver Spine Program, Vancouver General Hospital, Vancouver, British Columbia, Canada.|Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada.
M F
MF
Dvorak
D000465:Algorithms; D006801:Humans; D020407:Internet; D012720:Severity of Illness Index; D012984:Software; D013119:Spinal Cord Injuries / Q000145:classification*