{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T16:52:08Z","timestamp":1775148728515,"version":"3.50.1"},"reference-count":32,"publisher":"American Spinal Injury Association","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"\n Background:<\/jats:title>\n In 2020, a first, expedited version of the International Standards for Neurological Classification of Spinal Cord Injury (E-ISNCSCI-V1) was proposed for determination of neurological level of injury (NLI) and American Spinal Injury Association Impairment Scale (AIS) classifications.<\/jats:p>\n <\/jats:sec>\n \n Objectives:<\/jats:title>\n This work describes assessment of E-ISNCSCI-V1 classification accuracy and the development and data-based validation of an ISNCSCI Item Reduction Algorithm (IIRA).<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Classification accuracy for E-ISNCSCI-V1 examination shortcut options was assessed with automated analysis of 7026 full ISNCSCI examinations. Rules for the IIRA were iteratively adjusted to optimize the balance between omitting exam items and minimizing misclassification errors, and then it was validated through classification of 100 full ISNCSCI exams.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n If S1 findings are substituted for anorectal exam findings as proposed for E-ISNCSCI-V1, the error rate for AIS is 10%, with a high error rate (45%) for classifying true AIS B. The IIRA, which begins with full motor testing, followed by limited sensory testing required an average of 31% (42\/134) of the full ISNCSCI exam items, with a 2% error rate for NLI and no AIS errors.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n The previously proposed E-ISNCSCI-V1, which included an option to substitute S1 findings for anorectal exam findings, is not recommended due to AIS error rate. The IIRA provides a standardized option for a shortened examination classifying NLI and AIS with high accuracy. It will serve as a basis for version 2 of the E-ISNCSCI.<\/jats:p>\n <\/jats:sec>","DOI":"10.46292\/sci25-00008","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T17:05:28Z","timestamp":1755882328000},"page":"61-67","source":"Crossref","is-referenced-by-count":2,"title":["Development and Validation of an Algorithm for Item Reduction of the International Standards for Neurological Classification of Spinal Cord Injury Examination to Determine Level and Severity of SCI"],"prefix":"10.46292","volume":"31","author":[{"given":"Stephen P.","family":"Burns","sequence":"first","affiliation":[{"name":"Spinal Cord Injury Service, VA Puget Sound Health Care System, Seattle, Washington"},{"name":"Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen","family":"Walden","sequence":"additional","affiliation":[{"name":"Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Kirshblum","sequence":"additional","affiliation":[{"name":"Kessler Institute for Rehabilitation, West Orange, New Jersey"},{"name":"Rutgers New Jersey Medical School, Newark, New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Schmidt-Read","sequence":"additional","affiliation":[{"name":"Jefferson-Moss-Magee Rehabilitation, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith","family":"Tansey","sequence":"additional","affiliation":[{"name":"Spinal Cord Injury Clinic, Jackson VA Medical Center, Jackson, Mississippi"},{"name":"Departments of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Schuld","sequence":"additional","affiliation":[{"name":"Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany"},{"name":"Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruediger","family":"Rupp","sequence":"additional","affiliation":[{"name":"Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany"},{"name":"Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"25425","reference":[{"issue":"2","key":"b1","series-title":"Top Spinal Cord Inj Rehabil","first-page":"1","article-title":"International Standards for Neurological Classification of Spinal Cord Injury: Revised 2019","volume":"27","author":"Rupp R","year":"2021","unstructured":"Rupp R, Biering-S\u00f8rensen F, Burns SP, et al. International Standards for Neurological Classification of Spinal Cord Injury: Revised 2019. Top Spinal Cord Inj Rehabil. 2021;27(2):1-22. doi:10.46292\/sci2702-1."},{"issue":"1","key":"b2","series-title":"BMC Med","first-page":"225","article-title":"International surveillance study in acute spinal cord injury confirms viability of multinational clinical trials","volume":"20","author":"Bourguignon L","year":"2022","unstructured":"Bourguignon L, Tong B, Geisler F, et al. International surveillance study in acute spinal cord injury confirms viability of multinational clinical trials. BMC Med. 2022;20(1):225. doi:10.1186\/s12916-022-02395-0."},{"key":"b3","series-title":"Expedited ASIA ISNCSCI Exam (E-ISNCSCI), Version 1 (February 2020)","author":"American Spinal Injury Association","unstructured":"American Spinal Injury Association. Expedited ASIA ISNCSCI Exam (E-ISNCSCI), Version 1 (February 2020). Accessed January 12, 2025. https:\/\/asia-spinalinjury.org\/expedited-isncsci-exam\/."},{"issue":"6","key":"b4","series-title":"Spinal Cord","first-page":"633","article-title":"The Expedited International Standards for Neurological Classification of Spinal Cord Injury (E-ISNCSCI)","volume":"58","author":"Burns SP","year":"2020","unstructured":"Burns SP, Tansey KE. The Expedited International Standards for Neurological Classification of Spinal Cord Injury (E-ISNCSCI). Spinal Cord. 2020;58(6):633-634. doi:10.1038\/s41393-020-0462-2."},{"issue":"5","key":"b5","series-title":"Spine J","first-page":"389","article-title":"Sacral sparing in SCI: Beyond the S4-S5 and anorectal examination","volume":"12","author":"Zariffa J","year":"2012","unstructured":"Zariffa J, Kramer JL, Jones LA, et al. Sacral sparing in SCI: Beyond the S4-S5 and anorectal examination. Spine J. 2012;12(5):389-400.e3. doi:10.1016\/j.spinee.2012.03.028."},{"issue":"1","key":"b6","series-title":"Spinal Cord","first-page":"22","article-title":"The Rick Hansen Spinal Cord Injury Registry (RHSCIR): A national patient-registry","volume":"50","author":"Noonan VK","year":"2012","unstructured":"Noonan VK, Kwon BK, Soril L, et al. The Rick Hansen Spinal Cord Injury Registry (RHSCIR): A national patient-registry. Spinal Cord. 2012;50(1):22-27. doi:10.1038\/sc.2011.109."},{"key":"b7","series-title":"Top Spinal Cord Inj Rehabil","first-page":"165","article-title":"A Look at Spinal Cord Injury in Canada: Rick Hansen Spinal Cord Injury Registry (RHSCIR) - 2021 SCI data summary","volume":"29","author":"Noonan VK","year":"2023","unstructured":"Noonan VK. A Look at Spinal Cord Injury in Canada: Rick Hansen Spinal Cord Injury Registry (RHSCIR) - 2021 SCI data summary. Top Spinal Cord Inj Rehabil. 2023;29(Suppl):165-170. doi:10.46292\/sci23-00031S."},{"issue":"3","key":"b8","series-title":"Spinal Cord","first-page":"197","article-title":"Development and validation of a computerized algorithm for International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)","volume":"54","author":"Walden K","year":"2016","unstructured":"Walden K, B\u00e9langer LM, Biering-S\u00f8rensen F, et al. Development and validation of a computerized algorithm for International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Spinal Cord. 2016;54(3):197-203. doi:10.1038\/sc.2015.137."},{"issue":"2","key":"b9","series-title":"Spinal Cord","first-page":"125","article-title":"Computer International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) algorithms: A review","volume":"61","author":"Walden K","year":"2023","unstructured":"Walden K, Schuld C, Noonan VK, Rupp R. Computer International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) algorithms: A review. Spinal Cord. 2023;61(2):125-132. doi:10.1038\/s41393-022-00854-2."},{"key":"b10","series-title":"Clinicaltrials.gov","author":"European Multicentre Study of Human Spinal Cord Injury","unstructured":"European Multicentre Study of Human Spinal Cord Injury. Clinicaltrials.gov. Accessed January 12, 2025. https:\/\/clinicaltrials.gov\/study\/NCT01571531."},{"issue":"5","key":"b11","series-title":"J Spinal Cord Med","first-page":"616","article-title":"Reliability of S3 pressure sensation and voluntary hip adduction\/toe flexion and agreement with deep anal pressure and voluntary anal contraction in classifying persons with traumatic spinal cord injury","volume":"43","author":"Marino RJ","year":"2020","unstructured":"Marino RJ, Schmidt-Read M, Chen A, et al. Reliability of S3 pressure sensation and voluntary hip adduction\/toe flexion and agreement with deep anal pressure and voluntary anal contraction in classifying persons with traumatic spinal cord injury. J Spinal Cord Med. 2020;43(5):616-622. doi:10.1080\/10790268.2019.1628496."},{"issue":"21","key":"b12","series-title":"J Neurotrauma","first-page":"1936","article-title":"Early rapid neurological assessment for acute spinal cord injury trials","volume":"33","author":"Battistuzzo CR","year":"2016","unstructured":"Battistuzzo CR, Smith K, Skeers P, et al. Early rapid neurological assessment for acute spinal cord injury trials. J Neurotrauma. 2016;33(21):1936-1945. doi:10.1089\/neu.2015.4360."},{"key":"b13","series-title":"Global Spine J","article-title":"Validation of a new tool to detect and characterize spinal cord injury in the acute trauma patient: The Montreal acute classification of spinal cord injury","author":"Pelletier-Roy R","year":"2023","unstructured":"Pelletier-Roy R, Dionne A, Richard-Denis A, Briand MM, Bourassa-Moreau \u00c9, Mac-Thiong JM. Validation of a new tool to detect and characterize spinal cord injury in the acute trauma patient: The Montreal acute classification of spinal cord injury. Global Spine J. Published online September 21, 2023. doi:10.1177\/21925682231202447."},{"issue":"3","key":"b14","series-title":"J Neurotrauma","first-page":"453","article-title":"Computer implementation of the international standards for neurological classification of spinal cord injury for consistent and efficient derivation of its subscores including handling of data from not testable segments","volume":"29","author":"Schuld C","year":"2012","unstructured":"Schuld C, Wiese J, Hug A, et al. Computer implementation of the international standards for neurological classification of spinal cord injury for consistent and efficient derivation of its subscores including handling of data from not testable segments. J Neurotrauma. 2012;29(3):453-461. doi:10.1089\/neu.2011.2085."},{"issue":"9","key":"b15","series-title":"J Neurotrauma","first-page":"1267","article-title":"Characterizing natural recovery after traumatic spinal cord injury","volume":"38","author":"Kirshblum S","year":"2021","unstructured":"Kirshblum S, Snider B, Eren F, Guest J. Characterizing natural recovery after traumatic spinal cord injury. J Neurotrauma. 2021;38(9):1267-1284. doi:10.1089\/neu.2020.7473."},{"issue":"1","key":"b16","series-title":"Spinal Cord","first-page":"18","article-title":"A taxonomy for consistent handling of conditions not related to the spinal cord injury (SCI) in the International Standards for Neurological Classification of SCI (ISNCSCI)","volume":"60","author":"Rupp R","year":"2022","unstructured":"Rupp R, Schuld C, Biering-S\u00f8rensen F, et al. A taxonomy for consistent handling of conditions not related to the spinal cord injury (SCI) in the International Standards for Neurological Classification of SCI (ISNCSCI). Spinal Cord. 2022;60(1):18-29. doi:10.1038\/s41393-021-00646-0."},{"issue":"2","key":"b1","series-title":"Top Spinal Cord Inj Rehabil","first-page":"1","article-title":"International Standards for Neurological Classification of Spinal Cord Injury: Revised 2019","volume":"27","author":"Rupp R","year":"2021","unstructured":"Rupp R, Biering-S\u00f8rensen F, Burns SP, et al. International Standards for Neurological Classification of Spinal Cord Injury: Revised 2019. 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Accessed January 12, 2025. https:\/\/asia-spinalinjury.org\/expedited-isncsci-exam\/."},{"issue":"6","key":"b4","series-title":"Spinal Cord","first-page":"633","article-title":"The Expedited International Standards for Neurological Classification of Spinal Cord Injury (E-ISNCSCI)","volume":"58","author":"Burns SP","year":"2020","unstructured":"Burns SP, Tansey KE. The Expedited International Standards for Neurological Classification of Spinal Cord Injury (E-ISNCSCI). Spinal Cord. 2020;58(6):633-634. doi:10.1038\/s41393-020-0462-2."},{"issue":"5","key":"b5","series-title":"Spine J","first-page":"389","article-title":"Sacral sparing in SCI: Beyond the S4-S5 and anorectal examination","volume":"12","author":"Zariffa J","year":"2012","unstructured":"Zariffa J, Kramer JL, Jones LA, et al. Sacral sparing in SCI: Beyond the S4-S5 and anorectal examination. Spine J. 2012;12(5):389-400.e3. doi:10.1016\/j.spinee.2012.03.028."},{"issue":"1","key":"b6","series-title":"Spinal Cord","first-page":"22","article-title":"The Rick Hansen Spinal Cord Injury Registry (RHSCIR): A national patient-registry","volume":"50","author":"Noonan VK","year":"2012","unstructured":"Noonan VK, Kwon BK, Soril L, et al. The Rick Hansen Spinal Cord Injury Registry (RHSCIR): A national patient-registry. Spinal Cord. 2012;50(1):22-27. doi:10.1038\/sc.2011.109."},{"key":"b7","series-title":"Top Spinal Cord Inj Rehabil","first-page":"165","article-title":"A Look at Spinal Cord Injury in Canada: Rick Hansen Spinal Cord Injury Registry (RHSCIR) - 2021 SCI data summary","volume":"29","author":"Noonan VK","year":"2023","unstructured":"Noonan VK. A Look at Spinal Cord Injury in Canada: Rick Hansen Spinal Cord Injury Registry (RHSCIR) - 2021 SCI data summary. Top Spinal Cord Inj Rehabil. 2023;29(Suppl):165-170. doi:10.46292\/sci23-00031S."},{"issue":"3","key":"b8","series-title":"Spinal Cord","first-page":"197","article-title":"Development and validation of a computerized algorithm for International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)","volume":"54","author":"Walden K","year":"2016","unstructured":"Walden K, B\u00e9langer LM, Biering-S\u00f8rensen F, et al. Development and validation of a computerized algorithm for International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Spinal Cord. 2016;54(3):197-203. doi:10.1038\/sc.2015.137."},{"issue":"2","key":"b9","series-title":"Spinal Cord","first-page":"125","article-title":"Computer International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) algorithms: A review","volume":"61","author":"Walden K","year":"2023","unstructured":"Walden K, Schuld C, Noonan VK, Rupp R. Computer International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) algorithms: A review. Spinal Cord. 2023;61(2):125-132. doi:10.1038\/s41393-022-00854-2."},{"key":"b10","series-title":"Clinicaltrials.gov","author":"European Multicentre Study of Human Spinal Cord Injury","unstructured":"European Multicentre Study of Human Spinal Cord Injury. Clinicaltrials.gov. Accessed January 12, 2025. https:\/\/clinicaltrials.gov\/study\/NCT01571531."},{"issue":"5","key":"b11","series-title":"J Spinal Cord Med","first-page":"616","article-title":"Reliability of S3 pressure sensation and voluntary hip adduction\/toe flexion and agreement with deep anal pressure and voluntary anal contraction in classifying persons with traumatic spinal cord injury","volume":"43","author":"Marino RJ","year":"2020","unstructured":"Marino RJ, Schmidt-Read M, Chen A, et al. Reliability of S3 pressure sensation and voluntary hip adduction\/toe flexion and agreement with deep anal pressure and voluntary anal contraction in classifying persons with traumatic spinal cord injury. J Spinal Cord Med. 2020;43(5):616-622. doi:10.1080\/10790268.2019.1628496."},{"issue":"21","key":"b12","series-title":"J Neurotrauma","first-page":"1936","article-title":"Early rapid neurological assessment for acute spinal cord injury trials","volume":"33","author":"Battistuzzo CR","year":"2016","unstructured":"Battistuzzo CR, Smith K, Skeers P, et al. Early rapid neurological assessment for acute spinal cord injury trials. J Neurotrauma. 2016;33(21):1936-1945. doi:10.1089\/neu.2015.4360."},{"key":"b13","series-title":"Global Spine J","article-title":"Validation of a new tool to detect and characterize spinal cord injury in the acute trauma patient: The Montreal acute classification of spinal cord injury","author":"Pelletier-Roy R","year":"2023","unstructured":"Pelletier-Roy R, Dionne A, Richard-Denis A, Briand MM, Bourassa-Moreau \u00c9, Mac-Thiong JM. Validation of a new tool to detect and characterize spinal cord injury in the acute trauma patient: The Montreal acute classification of spinal cord injury. Global Spine J. Published online September 21, 2023. doi:10.1177\/21925682231202447."},{"issue":"3","key":"b14","series-title":"J Neurotrauma","first-page":"453","article-title":"Computer implementation of the international standards for neurological classification of spinal cord injury for consistent and efficient derivation of its subscores including handling of data from not testable segments","volume":"29","author":"Schuld C","year":"2012","unstructured":"Schuld C, Wiese J, Hug A, et al. Computer implementation of the international standards for neurological classification of spinal cord injury for consistent and efficient derivation of its subscores including handling of data from not testable segments. 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A taxonomy for consistent handling of conditions not related to the spinal cord injury (SCI) in the International Standards for Neurological Classification of SCI (ISNCSCI). 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