Archives of Physical Medicine and Rehabilitation
Year, Volume, Issue, Page(s):, Epub, ,
Objective: To determine if the "sacral sparing" definition for completeness of traumatic spinal cord injury (SCI) is a more stable definition than the previously used Frankel Classification.
Design: Retrospective analysis of persons enrolled in the Spinal Cord Injury Model Systems (SCIMS) database from 2011-2018.
Setting: SCIMS centers.
Participants: Individuals (N=804) with traumatic SCI, age >16 years at time of injury, admission to rehabilitation within 30 days, ASIA Impairment Scale (AIS) grades A- D at admission, and complete neurological data at admission and 1-year.
Intervention: None applicable.
Main outcome measures: Frankel and AIS scores were computed for a cohort of 804 eligible cases. Stability was compared between the two classification systems by calculating the proportions of cases where regression (conversion to a more severe impairment level) was observed.
Results: A larger proportion of persons classified with "incomplete" injuries (grades B-D) at admission using the Frankel system regressed to complete status at 1-year compared to the AIS criteria (9.4% vs 2.0%). Those with B grade injuries regressed to A more often using Frankel as compared to the AIS system (19.7% to 5.4%). A larger proportion of people diagnosed as Frankel C or D regressed to Frankel A, as compared to AIS C or D who regressed to AIS A (5.0% to 1.1%).
Conclusion: Greater number of persons diagnosed with neurologically incomplete SCI regressed to complete status at 1-year when using the Frankel compared to the AIS classification which is based upon sacral sparing. This reinforces the finding that the "sacral sparing" definition is a more stable classification in traumatic SCI.
Steven Kirshblum, Amanda Botticello, John Benedetto, Jayne Donovan, Ralph Marino, Shelly Hsieh, Nicole Wagaman