Validation of a rapid neurological assessment of spinal cord injury (SPEED): a substudy of the ICED trial
A requirement for a clinical trial evaluating hypothermia or other therapies very early after spinal cord injury (SCI) is a pre-therapy assessment capable of determining the severity and level of SCI. Because these two factors principally determine outcome, they are essential to determine before initiating a therapy. The existing American Spinal Injury Association Impairment Scale (AIS) sensory and motor assessment is lengthy, requires considerable experience and relies heavily on accurate evaluation of anal sphincter motor and sensory function. These factors render this assessment impractical in the acute setting.
Based on the study of van Middendorp et al. (2011) and other studies of early assessment, we developed a brief neurological examination called SPEED (SPinal Emergency Evaluation of Deficits) to rapidly determine the severity and level of SCI. This assessment evaluates foot motor function (L4 or L5) and sensory function (S1) to indicate the severity of injury and C3 sensation, hand grip strength and spinal pain level to indicate whether injury is in the high cervical, low and mid cervical or thoracic regions.
Validation of the SPEED assessment will consist of; 1) a preliminary determination of the ability of the assessment to predict severity and level of spinal cord injury in a retrospective patient cohort, followed by; 2) a prospective validation study in a cohort of patients with suspected SCI.
The retrospective validation component has now been completed (Battistuzzo et al. 2016). With regard to injury severity, a high proportion of patients (94%) with no foot movement at the time of injury were initially diagnosed as motor complete (AIS grade A-B) on admission to hospital. Weak or absent hand grip strength appeared to be a positive confirmation of cervical SCI. Overall, the SPEED assessment appears to be a promising method of acutely determining the level and severity of cervical SCI in the first hours after injury.
Prospective validation of the SPEED assessment will commence shortly with the initial phase of paramedic training, in collaboration with Ambulance Victoria MICA and Air Ambulance paramedics. Patients will be assessed by paramedics within 2 hours of their injury, and the SPEED assessment will be correlated with neurological assessments performed during acute hospital admission (< 24 hours of injury) and at 6 months post-injury.
This project is part of the Immediate Cooling and Emergency Decompression (ICED) trial. Once validated, the SPEED assessment will allow the level and severity of spinal cord injury to be rapidly established in a pre-hospital setting, allowing appropriate patients to be selected for the future ICED trial in which cooling will be initiated by paramedics within 2h of injury followed by early spinal decompression surgery.
- Dr. Peter Batchelor, Senior Lecturer
- Dr. Camila Battistuzzo, Post-Doctoral Research Fellow
- Peta Skeers, Research Assistant
- Ambulance Victoria
- Austin Health
- Alfred Health
- Melbourne Health (Royal Melbourne Hospital)
- Royal Adelaide Hospital
- Royal Perth Hospital
- Immediate Cooling and Emergency Decompression (ICED) for the treatment of spinal cord injury: pilot, safety and feasibility studies (Neurotrauma-Funding Provider Project) awarded by Institute for Safety, Compensation and Recovery Research (ISCRR)
- Immediate Cooling and Emergency Decompression (ICED) for the treatment of spinal cord injury: pilot, safety and feasibility studies (Project Grant) awarded by NHMRC
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