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

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. Intraclas s correlation coefficients (ICC), 95% con. fidence 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 40.90 = high reliability; 0.75-0.90 = moderate reliability and < 0.75 = inadequate reliability. Results: Children of our 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 40.90 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.