Using a limited number of dermatomes as a predictor of the 56-dermatome test of the international standards for neurological classification of spinal cord injury in the pediatric population

Top Spinal Cord Inj Rehabil. 2013 Spring;19(2):114-20. doi: 10.1310/sci1902-114.

Abstract

Background: For young children with spinal cord injury (SCI), the sensory exam of the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) is long and arduous, often making it impossible to complete.

Objectives: In this study, we determine whether an abbreviated sensory exam provides comparable information to the full 56-dermatome exam.

Method: A total of 726 56-dermatome sensory exams were completed with 190 children and youth with SCI ranging in age from 3 to 21 years. The cohort was randomly split into test and validation groups. For the test group, a principal component analysis (PCA) was carried out separately for pin prick (PP) and light touch (LT) scores. From the PCA, a hierarchical cluster analysis was performed to identify the most influential set of 4, 8, 12, and 16 dermatomes. From the sensory exam data obtained from the validation group, a linear regression was performed to compare the limited-dermatome composite scores to the total 56-dermatome scores.

Results: For both LT and PP, the 16-dermatome test resulted in the best fit (0.86 and 0.87, respectively) with the 56-dermatome test and was comprised of dermatomes from both the left (7 dermatomes) and right (9 dermatomes) sides and at least 1 dermatome from each vertebral region bilaterally (cervical, thoracic, lumbar, sacral).

Conclusion: A 16-dermatome sensory exam provided a good correlation to the 56-dermatome exam. The shortened exam may be useful for evaluating children with SCI who cannot tolerate the full examination.

Keywords: neurologic evaluation; pediatrics; spinal cord injury.