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Using Clinical Vignettes and a Modified Expert Delphi Panel to Determine Parameters for Identifying Non-Traumatic Spinal Cord Injury in Health Administrative and Electronic Medical Record Databases

  • Arrani Senthinathan
    Correspondence
    Corresponding author Arrani Senthinathan, Rehabilitation Sciences, 500 University Ave, Toronto, ON, M5G 1V7
    Affiliations
    From the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada

    KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
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  • Shawna M. Cronin
    Affiliations
    From the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada

    KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
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  • Chester Ho
    Affiliations
    Division of Physical Medicine & Rehabilitation, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
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  • Peter W. New
    Affiliations
    Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Caulfield, Australia

    Department of Medicine & Rehabilitation and Aged Services Program, Kingston Centre, Monash Health, Cheltenham, Australia

    Epworth-Monash Rehabilitation Medicine Unit, Monash University, Richmond, Australia

    Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Prahran, Australia
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  • Sara JT. Guilcher
    Affiliations
    From the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada

    Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada

    Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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  • Vanessa K. Noonan
    Affiliations
    Praxis Spinal Cord Institute, Vancouver, Canada

    International Collaboration on Repair Discoveries, Vancouver, Canada
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  • B. Catherine Craven
    Affiliations
    KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, Canada

    Department of Medicine, University of Toronto, Toronto, Canada

    Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
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  • Sean Christie
    Affiliations
    Division of Neurosurgery, Dalhousie University, Halifax, Canada
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  • Eugene K. Wai
    Affiliations
    Division of Orthopaedic Surgery and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada

    Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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  • Eve C. Tsai
    Affiliations
    Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada

    Division of Neurosurgery, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Canada
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  • Vidya Sreenivasan
    Affiliations
    Physical Medicine and Rehabilitation, The Ottawa Hospital, Ottawa, Canada
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  • Jefferson Wilson
    Affiliations
    Division of Neurosurgery, University of Toronto, Toronto, Canada

    St. Michael's Hospital, Toronto, Canada
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  • Michael G. Fehlings
    Affiliations
    Division of Neurosurgery, University of Toronto, Toronto, Canada

    Department of Surgery and Epidemiology & Biostatistics, Western University, London, Canada
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  • Blayne Welk
    Affiliations
    Division of Neurosurgery and Division of Genetics and Development, Krembil Neuroscience Centre, University Health Network, Toronto, Canada
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  • Susan B. Jaglal
    Affiliations
    From the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada

    KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, Canada

    Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada

    Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Published:August 21, 2022DOI:https://doi.org/10.1016/j.apmr.2022.08.002

      Abstract

      Objective

      To obtain expert consensus on the parameters and etiologic conditions required to retrospectively identify cases of non-traumatic spinal cord injury (NTSCI) in health administrative and electronic medical record (EMR) databases based on the rating of clinical vignettes.

      Design

      A modified Delphi process included 2 survey rounds and 1 remote consensus panel. The surveys required the rating of clinical vignettes, developed after chart reviews and expert consultation. Experts who participated in survey rounds were invited to participate in the Delphi Consensus Panel.

      Setting

      An international collaboration using an online meeting platform.

      Participants

      Thirty-one expert physicians and/or clinical researchers in the field of spinal cord injury (SCI).

      Main Outcome Measure(s)

      Agreement on clinical vignettes as NTSCI. Parameters to classify cases of NTSCI in health administrative and EMR databases.

      Results

      In health administrative and EMR databases, cauda equina syndromes should be considered SCI and classified as a NTSCI or TSCI based on the mechanism of injury. A traumatic event needs to be listed for injury to be considered TSCI. To be classified as NTSCI, neurologic sufficient impairments (motor, sensory, bowel, and bladder) are required, in addition to an etiology. It is possible to have both a NTSCI and a TSCI, as well as a recovered NTSCI. If information is unavailable or missing in health administrative and EMR databases, the case may be listed as “unclassifiable” depending on the purpose of the research study.

      Conclusion

      The Delphi panel provided guidelines to appropriately classify cases of NTSCI in health administrative and EMR databases.

      Keywords

      List of abbreviations:

      EMR (electronic medical record), NTSCI (non-traumatic spinal cord injury), SCI (spinal cord injury), TSCI (traumatic spinal cord injury)
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