Using Clinical Vignettes and a Modified Expert Delphi Panel to Determine Parameters for Identifying Non-Traumatic...

Area of Science:

• Neurology
• Medical Informatics
• Epidemiology

Background:

• Accurate identification of non-traumatic spinal cord injury (NTSCI) in health administrative and electronic medical record (EMR) databases is challenging.
• Standardized parameters are needed for consistent case classification.

Purpose of the Study:

• To achieve expert consensus on parameters and etiologic conditions for retrospectively identifying NTSCI cases.
• To develop criteria for classifying NTSCI within health administrative and EMR databases.

Main Methods:

• A modified Delphi process involving two survey rounds and a consensus panel.
• Experts rated clinical vignettes to establish agreement on NTSCI identification.
• International collaboration utilizing an online meeting platform.

Main Results:

• Cauda equina syndromes are considered spinal cord injury (SCI) and classified as NTSCI or traumatic SCI (TSCI) based on injury mechanism.
• NTSCI classification requires neurologic impairments (motor, sensory, bowel, bladder) and an identified etiology.
• Cases can be classified as NTSCI, TSCI, both, recovered NTSCI, or 'unclassifiable' if data is missing.

Conclusions:

• The Delphi panel successfully provided guidelines for classifying NTSCI cases in health administrative and EMR databases.
• These guidelines will improve the accuracy and consistency of NTSCI identification in research and clinical practice.