Classifying incomplete spinal cord injury syndromes: Algorithms based on the international standards for neurological and functional classification of spinal cord injury patients
Kc. Hayes et al., Classifying incomplete spinal cord injury syndromes: Algorithms based on the international standards for neurological and functional classification of spinal cord injury patients, ARCH PHYS M, 81(5), 2000, pp. 644-652
Objective: To develop an objective and uniform means for classifying patien
ts with incomplete spinal cord injury (SCI) according to SCI syndromes.
Design: Criteria for assigning the syndromes (defined by the International
Standards for Neurological and functional Classification of SCI Patients) w
ere operationalized by means of sensory and motor scores and were incorpora
ted into a set of six independent algorithms and two composite algorithms.
Setting: A regional SCI rehabilitation center in Canada.
Patients: SCI patients (n = 56) with incomplete injuries (American Spinal I
njury Association classes B, C, D) and stable neurologic deficits.
Results: Individual algorithms allowed the highest classification rate but
with some patients meeting the criteria for more than one syndrome. A compo
site, differential allocation algorithm, with selected thresholds at decisi
on nodes, yielded a classification rate approximating that of the individua
l algorithms but without double classifications.
Conclusions: The composite algorithm provided an objective and standardized
means of assigning patients to syndromes based on clinically measurable se
nsory and motor scores. The thresholds used to implement criteria and the o
rder of decision nodes greatly influenced the outcomes and may be adjusted
to suit the needs of the classification. that is, embracing liberal or stri
ngent criteria. Controversy remains about the interpretation of some syndro
mes, and many patients remain unclassifiable because of mixed clinical pres
entation.