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Type: Journal article
Title: Achieving assessor accuracy on the International Standards for Neurological Classification of Spinal Cord Injury
Author: Armstrong, A.
Clark, J.
Ho, D.
Payne, C.
Nolan, S.
Goodes, L.
Harvey, L.
Marshall, R.
Galea, M.
Dunlop, S.
Citation: Spinal Cord, 2017; 55(11):994-1001
Publisher: Nature Publishing Group
Issue Date: 2017
ISSN: 1362-4393
Statement of
AJ Armstrong, JM Clark, DT Ho, CJ Payne, S Nolan, LM Goodes, LA Harvey, R Marshall, MP Galea, SA Dunlop, on behalf of the Clinical Trial Collaborators
Abstract: Study design: A retrospective audit of assessor accuracy using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) in three multicentre randomised controlled trials (SCIPA: Spinal Cord Injury and Physical Activity) spanning 2010-2014 with standards revised in 2011. Objectives: To investigate assessor accuracy of neurological classification after spinal cord injury. Setting: Australia and New Zealand. Methods: ISNCSCI examinations were undertaken by trained clinicians prior to randomisation. Data were recorded manually and ISNCSCI worksheets circulated to panels, consensus reached and worksheets corrected. An audit team used a 2014 computerised ISNCSCI algorithm to check manual worksheets. A second audit team assessed whether the 2014 computerised algorithm accurately reflected pre- and post-2011 ISNCSCI standards. Results: Of the 208 ISNCSCI worksheets, 24 were excluded. Of the remaining 184 worksheets, 47 (25.5%) were consistent with the 2014 computerised algorithm and 137 (74.5%) contained one or more errors. Errors were in motor (30.1%) or sensory (12.4%) levels, zone of partial preservation (24.0%), motor/sensory scoring (21.5%), ASIA Impairment Scale (AIS, 8.3%) and complete/incomplete classification (0.8%). Other difficulties included classification when anal contraction/sensation was omitted, incorrect neurological levels and violation of the 'motor follows sensory rule in non-testable myotomes' (7.4%). Panel errors comprised corrections that were incorrect or missed or incorrect changes to correct worksheets. Conclusion: Given inaccuracies in the manual ISNCSCI worksheets in this long-term clinical trial setting, continued training and a computerised algorithm are essential to ensure accurate scoring, scaling and classification of the ISNCSCI and confidence in clinical trials.
Keywords: Humans; Spinal Cord Injuries; Neurologic Examination; Retrospective Studies; Algorithms; Medical Audit; Australia; New Zealand
Rights: © 2017 International Spinal Cord Society All rights reserved
RMID: 0030073854
DOI: 10.1038/sc.2017.67
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Appears in Collections:Medicine publications

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