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Is determination between complete and incomplete traumatic spinal cord injury clinically relevant? Validation of the ASIA sacral sparing criteria in a prospective cohort of 432 patients
Spinal Cord, 06/01/09

van Middendorp JJ et al. – Of 4 sacral sparing criteria, the acute phase anal sensory score measurements do not contribute significantly to prognosis of independent ambulation. The combination of the acute phase voluntary anal contraction and the S4–5 LT and PP scores predicts significantly better chronic phase-independent ambulation outcomes than the currently used distinction between complete and incomplete spinal cord injury (SCI).

Methods

Prospective multicenter longitudinal cohort study to validate prognostic value of acute phase sacral sparing measurements for chronic phase-independent ambulation in pts with traumatic SCI
Setting: European Multicenter Study of Human Spinal Cord Injury (EM-SCI)
Analysis in 432 pts of these measurements:
Acute phase (0–15 days) American Spinal Injury Association (ASIA)/International Spinal Cord Society neurological standard scale (AIS) grades
ASIA sacral sparing measurements: S4–5 light touch (LT), S4–5 pin prick (PP), anal sensation and voluntary anal contraction
Chronic phase (6 or 12 mo) indoor mobility Spinal Cord Independence Measure (SCIM)
Calculations of positive and negative predictive values (PPV/NPV) and univariate and multivariate logistic regressions for all 4 sacral sparing criteria
Calculation of area under the receiver-operating characteristic curve (AUC) ratios of all regression equations

Results

To achieve independent ambulation 1-yr post-injury, a normal S4–5 PP score showed the best PPV
Best NPV reported in S4–5 LT score
Use of combination of only voluntary anal contraction and S4–5 LT and PP sensory scores showed significantly better discriminating results in prognosticating 1-yr independent ambulation vs use of currently used distinction between complete and incomplete SCI

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