Lecture to ISCoS (International Spinal Cord Society Hellenic Society Physical Medicine & Rehabilitation) Outcome Measures, Athens, Greece – 26-29/09/2004

Accuracy of ASIA Impairment Scale of Spinal Cord Injury Using the 2002 Standards

Linda Jones, PT, MS, Ralph J. Marino, MD, Steven Kirshblum, MD, Joseph Tal, PhD

Background: Despite its widespread use, the accuracy of the AIS (American Spinal Injury Association Impairment Scale) classification of spinal cord injury (SCI) using the 2002 International Standards for Neurological Classification (the Standards) has not been evaluated.

Methods: Eight physicians attending an investigators meeting for the Proneuron Phase II autologous incubated macrophage study for treatment of SCI Patients participated in a study of AIS grade reliability. Each physician determined AIS grade on 15 sample cases.  For each of these cases, an expert analyst’s AIS grade was used as the comparison standard.

 Results: Overall Kappa for agreement between physicians and the expert opinion was 0.685 (p < 0.001). Individual physician Kappas ranged between 0.444 and 0.907. The overall proportion of correct responses across physicians and cases was 77.5%. However, accuracy varied by true patient grade: 97.5%, 66.7%, 67.5%, 68.7% for Grades A, B, C, and D respectively (p = 0.003). Agreement for Grade A cases was higher than that for other Grades (p < 0.05), which did not differ significantly among themselves. 

Conclusions: 1) The reliability of the AIS, as measured by Kappa, is reasonable on average but should be improved. 2) Reliability training should focus on Grades B, C and D, as physicians already demonstrate high accuracy in determining Grade A.

Supported by Proneuron Biotechnologies