Prospectively Recorded versus Medical Record‐Derived Spinal Cord Injury Scores in Dogs with Intervertebral Disk Herniation

Abstract

Background: Validated spinal cord injury (SCI) scores have been established for veterinary species but are not uniformly used in practice.Hypothesis/objectives: To determine the level of agreement of SCI scores at the time of admission versus those assigned from reconstructed medical records in a population of dogs with intervertebral disk herniation (IVDH).Animals: Eighty-six client-owned dogs with confirmed IVDH. Methods: Retrospective study. Medical records were reviewed for history, physical examination, neurologic examination, and recorded Modified Frankel score (MFS) and Texas spinal cord injury score (TSCIS) at the time of admission. Three raters, all board-certified neurologists, assigned MFS and TSCIS based on digitized abstracted medical records to each patient. These scores were then compared to the recorded score at the time of admission.Results: Actual agreement for MFS and TSCIS derived from medical records by the 3 raters compared to prospectively derived MFS and TSCIS was 77.9 and 51.2%, respectively. A kappa value of 0.572 (95% CI 0.450, 0.694; P < .001) and an ICC of 0.533 (95% CI 0.410, 0.646; P < .001) were calculated for MFS scores. A kappa value of 0.100 (95% CI 0.000, 0.222; P = .107), and an ICC of 0.503 (95% CI 0.377, 0.620; P < .001) were calculated for TSCIS scores.Conclusions and Clinical Importance: Results showed that SCI scores recorded at the time of admission often do not agree with those retrospectively abstracted from medical records. Agreement was less when using the more complex TSCIS scale and therefore the MFS scale might be more appropriate for use in retrospective studies.

Clinical presentation and outcome of dogs treated medically or surgically for thoracolumbar intervertebral disc protrusion

“…Although an accepted neurological grading system was used, the majority of dogs were ambulatory at presentation and were therefore assigned a similar neurological grade, which likely limited recognition of more subtle differences in severity of clinical signs. The majority of validated grading systems for dogs with spinal disease are designed for dogs with acute thoracolumbar spinal disorders, such as IVDE (Witsberger and others 2012, Van Wie and others 2013, Radcliff and others 2014), with few studies focusing on grading dogs with chronic spinal disease (Lee and others 2015). Inherent to the study design, dogs could not be randomised to treatment modality, which is a major limitation of this study.…”

“…Neurological status was graded by the modified Frankel score which was defined as paraplegia with absent deep nociception (grade 0), paraplegia with absent superficial nociception (grade 1), paraplegia with nociception (grade 2), non-ambulatory paraparesis (grade 3), ambulatory paraparesis and ataxia (grade 4), spinal hyperaesthesia only (grade 5), or normal (no dysfunction or pain) (Van Wie and others 2013). …”

Prevalence, clinical presentation, prognosis, and outcome of 17 dogs with spinal shock and acute thoracolumbar spinal cord disease

“…Histopathologic examination would have been beneficial to determine the presence of a lumbar lesion; however, this was not performed due to the overall improvement. Alternative explanations for the longer recovery time include individual variation, observer error, recording error, 25 preexisting reflex deficits, or the presence of an unidentified secondary lesion in the lumbar intumescence.…”

Clinical characterization of thoracolumbar and lumbar intervertebral disk extrusions in English Cocker Spaniels

“…Neurologic deficits were defined as one or more of the following: proprioceptive deficits, reduced pelvic limb spinal reflexes, reduced perianal reflex, reduced anal tone, reduced tail tone, and reduced nociception of the tail, perianal region, or digits. Neurologic status was graded by the modified Frankel score, 16,17 which was defined as paraplegia with no deep nociception (grade 0), paraplegia with no superficial nociception (grade 1), paraplegia with nociception (grade 2), nonambulatory paraparesis (grade 3), ambulatory paraparesis and ataxia (grade 4), spinal hyperesthesia only (grade 5), or no dysfunction. The affected IVDS identified by diagnostic imaging findings was recorded, and IVDE sites were categorized by vertebral column region as thoracolumbar (T9-10 through L1-2 IVDSs), midlumbar (L2-3 through L4-5), or caudal lumbar (L5-6 through L7-S1 IVDSs).…”