Study design and setting

In this retrospective study, we evaluated 96 ISNCSCI charts of 24 traumatic spinal cord-injured (SCI) patients and 26 controls (vertebral fracture but no SCI), written by 50 clinicians in the neurosurgical unit of a regional trauma centre in the UK. The ISNCSCI charts were exclusively documented on paper. Only patients admitted from years 2012 to 2017 were included. Paediatric patients were excluded as this unit only treats adult patients.

In this hospital, the ISNCSCI is utilised predominantly clinically to diagnose SCI and monitor the patient’s neurology during admission. Clinical examination and neurophysiology studies are often carried out to differentiate SCI from non-SCI conditions such as traumatic plexopathy or neuropathy. Clinicians in the department are regularly advised to perform ISNCSCI within 24 h of the time of admission, immediate post-operative period and afterwards with any change in neurology identified at ward rounds. The senior clinicians (registrars and above) do a practical demonstration of the ISNCSCI examination and documentation to the junior doctors when they start the placement. The teaching is formalised but not standardised. In the present study, the clinicians involved in completing the ISNCSCI charts include two physiotherapists, two Specialist Registrars (SpR), seventeen Specialist/Core Trainees (ST/CT), eight Senior House Officers (SHO), ten Foundation Year 2 doctors (FY2), eight Foundation Year 1 doctors (FY1) and three final-year medical students.

The patient demographics considered in this study include age and gender. The injury-related factors considered are SCI severity (complete/incomplete), type of injury (tetraplegia/paraplegia), site of bony spine injury (cervical/thoracolumbar), non-spinal injury (including head injury (skull fracture, extradural and subdural haematoma), limb fracture, chest injury, abdominal injury, pelvic injury), spinal fusion surgery post-SCI (yes or no) and admission to intensive treatment unit (yes or no).