Severity assessment of impairment in spinal cord injury; a systematic review on challenging points about International Standards for Neurological Classification of Spinal Cord Injury

Mahmoud Yousefifard; Mostafa Hosseini; Alireza Oraii; Alexander R. Vaccaro; Vafa  Rahimi-Movaghar

doi:10.18502/fem.v6i2.8717

Mahmoud Yousefifard Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran.
Mostafa Hosseini Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Alireza Oraii Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Alexander R. Vaccaro Department of Orthopedics and Neurosurgery, Rothman Institute, Thomas Jefferson University Philadelphia, USA.
Vafa Rahimi-Movaghar Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/fem.v6i2.8717

Keywords: Limitation; Outcome Measures; Spinal Cord Injury; Systematic Review

Abstract

Objective: Assessment of spinal cord injuries (SCI) severity is usually done according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). However, a limitation of ISNCSCI has not been thoroughly evaluate; therefore, a systematic review was performed to gather current evidence on the limitations of the ISNCSCI for assessing SCI.

Methods: An extensive literature search was performed using Medline, Embase, Web of Science, Cochrane library, and Scopus for all articles up until the end of 2017 and then was updated to the end of 2020. Data was summarized by two independent reviewers and limitations of the ISNCSCI was further categorized.

Results: 31 studies were included in the analysis. The limitations of ISNCSCI were classified into 6 domains: 1) lack of assessment of autonomic nervous system; 2) low value in assessing severity of SCI severity in children; 3) confounding factors which impact outcome are not accounted for by ISNCSCI; 4) lack of an established optimal cut off time point for administering the ISNCSCI; 5) low predictive and diagnostic value for assessing incomplete motor injuries; 6) poor classification and predictive value of the ISNCSCI.

Conclusion: Although the ISNCSCI is a commonly used tool to assess the severity of SCI, there are several limitations.