Abstract
Study design
Observational.
Objectives
To assess accuracy of self-reported level of injury (LOI) and severity in individuals with chronic spinal cord injury (SCI) as compared with clinical examination.
Setting
An SCI Model System Hospital.
Methods
A 20-item survey evaluated demographics, physical abilities, and self-reported injury level and severity. A decision tree algorithm used responses to categorize participants into injury severity groups. Following the survey, participants underwent clinical examination to determine current injury level and severity. Participants were later asked three questions regarding S1 sparing. Chart abstraction was utilized to obtain initial injury level and severity. Injury level and severity from self-report, decision tree, clinical exam, and chart abstraction were compared.
Results
Twenty-eight individuals participated. Ninety-three percent correctly self-reported anatomical region of injury (ROI). Self-report of specific LOI matched current clinical LOI for 25% of participants, but matched initial LOI for 61%. Self-report of ASIA Impairment Scale (AIS) matched clinical AIS for 36%, but matched initial AIS for 46%. The injury severity decision tree was 75% accurate without, but 79% accurate with additional S1 questions. Self-report of deep anal pressure (DAP) was correct for 86% of participants, while self-report of voluntary anal contraction (VAC) was correct for 82%.
Conclusion
Individuals with SCI are more accurate reporting ROI than specific LOI. Self-reported injury level and severity align more closely with initial clinical examination results than current exam results. Using aggregate data from multiple questions can categorize injury severity more reliably than self-report. Using this type of decision tree may improve injury severity classification in large survey studies.
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Data availability
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
We would like to acknowledge the study participants who agreed to meet with us, even during COVID-19 protocols.
Funding
The contents of this article were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90SI5016). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this article do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.
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CLF was responsible for conceptualization and coordination of the project, data collection and writing the initial manuscript draft; RKA performed statistical analyses and contributed to manuscript development; ECFF contributed to development and revision of the manuscript, and the acquisition of financial support, all authors approved the final version of the manuscript.
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Furbish, C.L., Anderson, R.K. & Field-Fote, E.C. Accuracy of self-reported severity and level of spinal cord injury. Spinal Cord 60, 934–941 (2022). https://doi.org/10.1038/s41393-022-00855-1
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DOI: https://doi.org/10.1038/s41393-022-00855-1
