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. 2007 Nov;16(11):1951-7.
doi: 10.1007/s00586-007-0402-2. Epub 2007 Jun 5.

Development of a clinical diagnosis support tool to identify patients with lumbar spinal stenosis

Shinichi Konno  1 , Yasuaki Hayashino, Shunichi Fukuhara, Shinichi Kikuchi, Kiyoshi Kaneda, Atsushi Seichi, Kazuhiro Chiba, Kazuhiko Satomi, Kensei Nagata, Shinya Kawai
Affiliations

Development of a clinical diagnosis support tool to identify patients with lumbar spinal stenosis

Shinichi Konno et al. Eur Spine J. 2007 Nov.

Abstract

No clinical diagnostic support tool can help identify patients with LSS. Simple diagnostic tool may improve the accuracy of the diagnosis of LSS. The aim of this study was to develop a simple clinical diagnostic tool that may help physicians to diagnose LSS in patients with lower leg symptoms. Patients with pain or numbness of the lower legs were prospectively enrolled. The diagnosis of LSS by experienced orthopedic specialists was the outcome measure. Multivariable logistic regression analysis identified factors that predicted LSS; a simple clinical prediction rule was developed by assigning a risk score to each item based on the estimated beta-coefficients. From December 2002 to December 2004, 104 orthopedic physicians from 22 clinics and 50 hospitals evaluated 468 patients. Two items of physical examination, three items of patients' symptom, and five items of physical examination were included in the final scoring system as a result of multiple logistic regression analysis. The sum of the risk scores for each patient ranged from -2 to 16. The Hosmer-Lemeshow statistic was 11.30 (P = 0.1851); the area under the ROC curve was 0.918. The clinical diagnostic support tool had a sensitivity of 92.8% and a specificity of 72.0%. The prevalence of LSS was 6.3% in the bottom quartile of the risk score (-2 to 5) and 99.0% in the top quartile (12 to 16). We developed a simple clinical diagnostic support tool to identify patients with LSS. Further studies are needed to validate this tool in primary care settings.

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Figures

Fig. 1
Fig. 1
Flow chart showing how the diagnosis of LSS was determined. Diagnosis 1 denotes the diagnosis made by an orthopedic physician at each study site, and diagnosis 2 denotes the diagnosis made by the study coordinator. Of the 469 patients enrolled in this study, the diagnoses of 226 cases were consistent. Inconsistencies in the remaining 243 cases were resolved by a consensus panel meeting. Only one case was removed from the analysis because no agreement could be reached on the final diagnosis
Fig. 2
Fig. 2
Incidence of LSS stratified by risk score quartiles. Quartile 1 represents a risk score of −2 to 5, quartile 2 represents a risk score of 6 to 8, quartile 3 represents a risk score of 9 to 11, and quartile 4 represents a risk score of 12 to 17
See this image and copyright information in PMC

References

    1. Amundsen T, Weber H, Lilleas F, Nordal HJ, Abdelnoor M, Magnaes B. Lumbar spinal stenosis. Clinical and radiologic features. Spine. 1995;20:1178–1186. doi: 10.1097/00007632-199505150-00013. - DOI - PubMed
    1. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:315–324. doi: 10.1002/art.1780310302. - DOI - PubMed
    1. Beattie PF, Meyers SP, Stratford P, Millard RW, Hollenberg GM. Associations between patient report of symptoms and anatomic impairment visible on lumbar magnetic resonance imaging. Spine. 2000;25:819–828. doi: 10.1097/00007632-200004010-00010. - DOI - PubMed
    1. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990;72:403–408. - PubMed
    1. Chalmers I. Underreporting research is scientific misconduct. Jama. 1990;263:1405–1408. doi: 10.1001/jama.263.10.1405. - DOI - PubMed