The International Standards for Neurological Classification of Spinal Cord Injury: reliability of data when applied to children and youths

Spinal Cord. 2007 Jun;45(6):452-9. doi: 10.1038/ Epub 2006 Oct 3.


Study design: Intra-rater reliability study, cross-sectional design.

Objectives: To determine reliability of the International Standards for Neurological Classification of Spinal Cord Injury (ISCSCI) motor and sensory exam in children.

Setting: Nonprofit pediatric hospital.

Methods: In all, 74 subjects had two trials of the motor and sensory exams. Intraclass correlation coefficients (ICC), 95% confidence intervals (CI) were generated for total motor (TM), pin prick (PP) and light touch (LT) scores for the entire sample, four age groups, severity and type of injury. Coefficients >0.90=high reliability; 0.75-0.90=moderate reliability and <0.75=inadequate reliability.

Results: Children <four years (N=7) were unable to participate in the exams. TM ICC, CI=0.888, 0.821-0.93 (N=73); PP ICC, CI=0.975, 0.96-0.98 (N=67) and LT ICC, CI=0.974, 0.974-0.985 (N=68). When age was considered, 4-5 year: TM ICC, CI=0.917, 0.69-0.98 (N=11), PP=0.912, 0.49-0.985 (N=7), LT=0.948, 0.63-0.993 (N=6); for 6-11 year: TM ICC, CI=0.711, 0.226-0.892 (N=18), PP=0.952, 0.867-0.983 (M=17), LT=0.952, 0.867-0.983 (N=17); for 12-15 year: TM ICC, CI=0.893, 0.723-0.959 (N=19), PP=0.982, 0.953-0.993 (N=19), LT=0.982, 0.953-0.993 (N=19); for 16-21 year: TM ICC, CI=0.912, 0.80-0.961 (N=25), PP=0.98, 0.954-0.991 (N=25), LT=0.98, 0.954-0.991 (N=25). ICC for severity and type of injury >0.90 except for TM in complete injuries (0.808).

Conclusion: The ISCSCI exams may have poor utility in children under 4 years. While reliability values for the motor and sensory exams met or exceeded recommended values, wide CI suggest poor precision of the motor exam in children under 15 years of age and sensory exams in children under 5 years.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aging / physiology
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Diagnostic Errors / prevention & control
  • Disability Evaluation*
  • Female
  • Global Health
  • Humans
  • Infant
  • International Agencies / statistics & numerical data
  • International Classification of Diseases / standards*
  • International Classification of Diseases / statistics & numerical data*
  • Male
  • Movement Disorders / classification
  • Movement Disorders / diagnosis
  • Neurologic Examination / standards
  • Neurologic Examination / statistics & numerical data
  • Observer Variation
  • Predictive Value of Tests
  • Reproducibility of Results
  • Sensation Disorders / classification
  • Sensation Disorders / diagnosis
  • Spinal Cord Injuries / classification*
  • Spinal Cord Injuries / diagnosis*