An Evaluation of International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) Performance Within the Canadian SCI Network.

Abstract

Objectives: To describe the performance of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination in individuals with traumatic spinal cord injury (TSCI) and nontraumatic spinal cord injury (NTSCI) across Canadian acute and rehabilitation facilities, evaluating timing, completeness, and classification accuracy.

Methods: Using the Rick Hansen Spinal Cord Injury Registry (2015-2022), participants were analyzed across 6 cohorts: (A) TSCI-acute-admission (n = 4461), (B) TSCI-acute-discharge (n = 972), (C) TSCI-rehabilitation-admission (n = 2673), (D) TSCI-rehabilitation-discharge (n = 2316), (E) NTSCI-rehabilitation-admission (n = 728), and (F) NTSCI-rehabilitation-discharge (n = 619). ISNCSCI data included performed (yes/no), timing (≤72 hours, ≤7 days, and >7 days of admission/discharge), completeness, missing items, and worksheet used (yes/no). Classification accuracy between the clinician-determined and algorithm-generated ASIA Impairment Scale and neurological level of injury classification was evaluated. Descriptive and bivariate statistics were used to analyze cohorts.

Results: Overall, 70% of participants had at least one examination performed, with 76% performed ≤72 hours, 91% ≤7 days, and 9% >7 days. However, 45% were partially complete, primarily missing sensory scores and rectal components ≤7 days. Comparison of TSCI and NTSCI during rehabilitation showed that NTSCI cohorts had significantly more exams at admission and fewer at discharge, with more complete exams. Moreover, age at injury, injury type, mechanism, severity, length of stay, and pain influenced examination performance.

Conclusion: This study highlights the need for greater consistency in ISNCSCI examination performance and identifies patient-level barriers to completion. Determining the most effective standardized approach for ISNCSCI use across SCI care, addressing modifiable human/organizational factors, and ensuring comprehensive clinical training will improve the quality of this assessment.