title: Early Rapid Neurological Assessment for Acute Spinal Cord Injury Trials.
abstract: Clinical trials evaluating early therapies after spinal cord injury (SCI) are challenging because of the absence of a rapid assessment. The aim of this study was to determine whether the severity and level of SCI could be established from a brief neurological assessment capable of being used in an emergency setting. A brief assessment called the SPinal Emergency Evaluation of Deficits (SPEED) was developed and retrospectively evaluated in a cohort of 118 patients with SCI. Foot motor and sensory function was used to indicate injury severity. C3 dermatome sensation, handgrip strength and location of spinal pain were used to indicate the level of injury. With regard to injury severity, a high proportion of patients (94%) with no foot movement at the time of injury were initially diagnosed as motor complete (American Spinal Injury Association Impairment Scale [AIS] grade A-B), whereas all patients with foot movement were identified as motor incomplete (AIS grade C-D). This was reflected by a good correlation (rs= 0.79) and agreement (κ = 0.85) between the SPEED motor score and the acute hospital assessment. With respect to injury level, the majority of cases with cervical SCI (92%) had no or weak handgrip at the time of paramedic assessment, whereas all cases with thoracolumbar SCI had a strong handgrip. The location of spinal pain was also in accordance with the level of spinal injury. The SPEED assessment appears capable of accurately determining the severity and level of cervical SCI in the first hours post-injury. A neurological assessment that can be performed rapidly after injury is important for clinical trials of early therapy and to identify patients most likely to benefit from intervention.
authors.affiliation: 1 Department of Medicine (Royal Melbourne Hospital), The University of Melbourne , Melbourne, VIC, Australia .
authors.forename: Camila R
authors.initials: CR
authors.lastname: Battistuzzo
authors.affiliation: 2 Department of Epidemiology and Preventive Medicine, Monash University and Ambulance Victoria , Melbourne VIC, Australia .
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
authors.affiliation: 1 Department of Medicine (Royal Melbourne Hospital), The University of Melbourne , Melbourne, VIC, Australia .
authors.forename: Peta
authors.initials: P
authors.lastname: Skeers
authors.affiliation: 3 School of Animal Biology, The University of Western Australia , Perth, WA, Australia .
authors.forename: Alex
authors.initials: A
authors.lastname: Armstrong
authors.affiliation: 4 Centre for Orthopaedic and Trauma Research, Faculty of Health Sciences, The University of Adelaide , Adelaide, SA, Australia .
authors.forename: Jillian
authors.initials: J
authors.lastname: Clark
authors.affiliation: 1 Department of Medicine (Royal Melbourne Hospital), The University of Melbourne , Melbourne, VIC, Australia .
authors.forename: Jacqui
authors.initials: J
authors.lastname: Agostinello
authors.affiliation: 2 Department of Epidemiology and Preventive Medicine, Monash University and Ambulance Victoria , Melbourne VIC, Australia .
authors.forename: Shelley
authors.initials: S
authors.lastname: Cox
authors.affiliation: 2 Department of Epidemiology and Preventive Medicine, Monash University and Ambulance Victoria , Melbourne VIC, Australia .
authors.forename: Stephen
authors.initials: S
authors.lastname: Bernard
authors.affiliation: 4 Centre for Orthopaedic and Trauma Research, Faculty of Health Sciences, The University of Adelaide , Adelaide, SA, Australia .|5 Department of Orthopaedics and Trauma, Royal Adelaide Hospital , Adelaide, SA, Australia .
authors.forename: Brian J C
authors.initials: BJ
authors.lastname: Freeman
authors.affiliation: 3 School of Animal Biology, The University of Western Australia , Perth, WA, Australia .
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Dunlop
authors.affiliation: 1 Department of Medicine (Royal Melbourne Hospital), The University of Melbourne , Melbourne, VIC, Australia .
authors.forename: Peter E
authors.initials: PE
authors.lastname: Batchelor
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000503:physiopathology*; D055815:Young Adult
keywords: SCI; injury severity; level of injury; rapid neurological assessment