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Terminology..complete-incomplete vs. ASIA

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  • Terminology..complete-incomplete vs. ASIA

    From my readings on these forums over the years, I've learned that the terms "complete" and "incomplete" are passe'. ASIA classification is the proper way to evaluate a spinal cord injury, and predict recovery outcome.

    1. Are insurance companies using complete/incomplete or ASIA?

    2. Why does the community itself continue to use the wrong terms?

    3. Why does the "Average Josephine" like to ask..."was your cord severed?"

    If even we as a community continue to be small minded and lazy about the terms we use, how can we expect anything different from the medical professions and research?

  • #2
    AMERICAN Spinal Injury Association ... there's your answer. Never heard of it until I came here as a Canadian.
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

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    • #3
      Actually, the exam is no longer called the ASIA (which was developed by the American Spinal Injury Association, which has Canadian members as well). Several years ago, the ASIA exam was also adopted by ISCoS (The International Spinal Cord Society), which has members all over the world, and at that time the exam was renamed the International Standards for Neurologic Classification of Spinal Cord Injury (ISNCSCI). The ASIA title is not supposed to be used anymore for the exam, but old habits die hard, and there is no easy short hand for ISCNSCI, so many clinicians continue to use that term.

      http://www.asia-spinalinjury.org/elearning/ISNCSCI.php

      Many also use the term (incorrectly) "ASIA A" (for complete) or "ASIA B, C, D, or E" for incomplete injuries. The correct abbreviation is actually "AIS A" or "AIS B (C, D, or E)". AIS stands for "ASIA Impairment Scale". It is part of scoring the ISCNSCI. The ISCNSCI tests sensation in all dermatomes (pin prick for pain, cotton wisp for touch), key muscles (on the 0-5 scale) and determines the LOI (level of injury). Additionally, once the exam is done, the information is used to determine the AIS. The injury then should be described as the LOI + the AIS. For example: C6 AIS B, or T10 AIS A, or T4 AIS C, etc.

      In addition, many clinicians have not been properly trained to do the ISNCSCI (or the ASIA). It is not routinely included in education for neurologists or neurosurgeons unless they work in a major SCI Center during their training, or are doing research related to SCI. Most physiatrists are trained in it, but if they did not also do a spinal cord fellowship, or become board certified in Spinal Cord Medicine as well, or spend most of their practice doing SCI care, they get rusty and often sloppy in administering the exam. Even at the center where I work, we found we had to require the physicians and PAs, who do only SCI care in their practice, to retake the ASIA website training/certification course in using the ISNCSCI annually in order to maintain competency.

      Insurance companies use the ICD 9, or ICD 10 (which is newly rolled out and replacing the ICD 9) for all medical diagnoses. This does NOT entail the ISNCSCI specifically.

      You can see the ICD 10 codes here just for thoracic injuries: http://www.icd10data.com/ICD10CM/Cod...8/S20-S29/S24-
      Here are the codes for cervical injuries: http://www.icd10data.com/ICD10CM/Cod...8/S10-S19/S14-
      and lumbar injury codes: http://www.icd10data.com/ICD10CM/Cod...8/S30-S39/S34-
      and cauda equina codes: http://www.icd10data.com/ICD10CM/Cod.../S34-/S34.3XXS

      (KLD)
      Last edited by SCI-Nurse; 08-23-2015, 03:34 PM. Reason: corrected error
      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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      • #4
        Interesting. Had no idea! Wish it would stop changing, lol!
        Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

        T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

        Comment


        • #5
          Anticipate it changing again within a few years, as the push to include trunk muscle assessment/testing is becoming stronger. Currently only arm and leg muscles are assessed, with thoracic injury level being based only on sensation. Dr. Young has been part of the development and revision of these standards, so may weigh in on this too.

          (KLD)
          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

          Comment


          • #6
            Is it just me? Or is there a "war" on cancer....but curing spinal cord injury is somebody's DIY project in the back of their garage? "Someday!..." you get it

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            • #7
              Here's an example: Even University of Alabama uses the term "complete/incomplete" in their literature.

              https://www.uab.edu/medicine/sci/faq...al-cord-injury

              What is the benefit to the community as a whole by keeping them misinformed and stupid about the complexity of the injury and recovery outcomes? It's not rocket science...it's a simple lab exam

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              • #8
                The terms complete and incomplete are not incorrect, they are just not as specific as the AIS scale, nor the definitions for the incomplete syndromes (anterior cord syndrome, Brown-Sequard, central cord syndrome, posterior cord syndrome, etc.). Those are still legitimately used to describe the extent of injury, legitimate diagnoses, and used by health care professionals the world over.

                (KLD)
                The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                Comment


                • #9
                  Since we are on the topic of ICD-10, I found this to be the most robust and user-friendly ICD-10 tool. It has all codes and even provides a free training tool to use.

                  nuemd.com/icd-10/codes

                  Nick

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                  • #10
                    From a class my PCA is taking

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                    • #11
                      The thing is, many of us old timers weren't and haven't been classified on the ASIA/ASI scale, so we report what our classification was when we were injured, back in the dark ages.....C6/7 complete.

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                      • #12
                        Does it in anyway effect how the medical community treats you ?? Just another box for them to write in on their forms!

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                        • #13
                          In my experience, the "medical community" wouldn't have a clue or care if you told them you were SCI C6/7 complete or gave them some ASUA or ASI equivalent. They the "medical community" in a local, community medical environment is basically clueless and need to be educated, and that is generally left to each of us to make our way and try to get the best possible care. Many, I might conjecture most of us don't have the benefit of care in a setting where our needs are understood.

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