International Standards for Neurological Classification of Spinal Cord Injury: factors influencing the frequency, completion and accuracy of documentation of neurology for patients with traumatic spinal cord injuries

Temidayo Osunronbi,Himanshu Sharma

doi:10.1007/s00590-019-02502-7

Abstract

IntroductionWe aim to evaluate the effects of injury-related factors and clinician training grades on the frequency, completion and accuracy of International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) charts in a tertiary care neurosurgery unit.Materials and methodsWe retrospectively analysed 96 ISNCSCI charts of 24 traumatic spinal cord-injured (SCI) patients and 26 controls (vertebral fracture but neurologically intact), written by 50 clinicians. Seven components of each ISNCSCI charts (motor scores, sensory scores, sensory levels, motor levels, neurological level of injury, SCI severity and AIS) were reviewed to evaluate the effect of injury factors and clinician grade on the completion and accuracy of the ISNCSCI components.ResultsThe ISNCSCI chart was used 1.9 times on average during admission. The number of ISNCSCI assessments was significant in those with isolated spinal injuries (p = 0.03). The overall completion and accuracy rates of the assessed ISNCSCI chart components were 39% and 78.1%, respectively. Motor levels and AIS had the lowest completion rates. Motor levels and sensory levels had the lowest accuracy rates. The completion rate was higher in the charts of male patients, tetraplegic patients, and in patients with isolated spinal injuries. The junior clinicians had a significantly greater ISNCSCI chart completion rate than their seniors. However, the senior clinicians were more accurate in completing the ISNCSCI chart components.ConclusionThe quality of ISNCSCI documentation remained poor regardless of the clinician training grade and injury factors. Clinicians should be educated on the ISNCSCI protocol and the importance of adequate documentation.

Highlights

Introduction We aim to evaluate the effects of injury-related factors and clinician training grades on the frequency, completion and accuracy of International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) charts in a tertiary care neurosurgery unit
The clinicians involved in completing the ISNCSCI charts include two physiotherapists, two Specialist Registrars (SpR), seventeen Specialist/Core Trainees (ST/CT), eight Senior House Officers (SHO), ten Foundation Year 2 doctors (FY2), eight Foundation Year 1 doctors (FY1) and three final-year medical students
Future research could use questionnaires and focus-group discussions to investigate the specific reasons why clinicians do not document ISNCSCI charts comprehensively. Understanding why this occurs is necessary to design a proper approach for solutions. The dataset from this retrospective study suggests that gender, absence or presence of non-spinal injuries, injury type and clinician training grade may influence ISNCSCI documentation patterns for patients with traumatic spinal cord-injured (SCI) admitted to an acute neurosurgical unit

Summary

Introduction

We aim to evaluate the effects of injury-related factors and clinician training grades on the frequency, completion and accuracy of International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) charts in a tertiary care neurosurgery unit. The ISNCSCI involves a physical examination and the documentation of total motor and sensory scores, motor and sensory levels as well as a single neurological level of injury, an ASIA Impairment Scale, and severity of injury (complete/incomplete) [2, 4]. Clinicians can use these parameters from ISNCSCI to provide prognostic information such as the ability to walk, to patients and their families [4, 5]. No study has evaluated ISNCSCI chart completion and accuracy of documentation in a busy day-to-day clinical setting

Objectives

Methods

Discussion

Conclusion