Severity assessment of impairment in spinal cord injury; a systematic review on challenging points about International Standards for Neurological Classification of Spinal Cord Injury

Objective: Assessment of spinal cord injuries (SCI) severity is usually done according to the International Standards for Neurological Classification Spinal Cord Injury (ISNCSCI). However, a limitation ISNCSCI has not been thoroughly evaluate; therefore, systematic review was performed gather current evidence on limitations assessing SCI.
 Methods: An extensive literature search using Medline, Embase, Web Science, Cochrane library, and Scopus all articles up until end 2017 then updated 2020. Data summarized by two independent reviewers further categorized.
 Results: 31 studies were included in analysis. The classified into 6 domains: 1) lack assessment autonomic nervous system; 2) low value SCI children; 3) confounding factors which impact outcome are accounted ISNCSCI; 4) an established optimal cut off time point administering 5) predictive diagnostic incomplete motor injuries; 6) poor classification ISNCSCI.
 Conclusion: Although commonly used tool assess SCI, there several limitations.