Litaker D, Pioro M, El Bilbeisi H, Brems J
Department of General Internal Medicine, The Cleveland Clinic Foundation, Ohio 44195, USA.
J Am Geriatr Soc. 2000 Dec;48(12):1633-7. doi: 10.1111/j.1532-5415.2000.tb03875.x.
To determine the value of elements of the bedside history and physical examination in predicting arthrography results in older patients with suspected rotator cuff tear (RCT).
Retrospective chart review
Orthopedic practice limited to disorders of the shoulder
448 consecutive patients with suspected RCT referred for arthrography over a 4-year period
Presence of partial or complete RCT on arthrogram
301 patients (67.2%) had evidence of complete or partial RCT. Clinical findings in the univariate analysis most closely associated with rotator cuff tear included infra- and supraspinatus atrophy (P < .001), weakness with either elevation (P < .001) or external rotation (P < .001), arc of pain (P = .004), and impingement sign (P = .01). Stepwise logistic regression based on a derivation dataset (n = 191) showed that weakness with external rotation (Adjusted Odds Ratio (AOR) 6.96 (3.09, 13.03)), age > or = 65 (AOR 4.05(2.47, 16.07)), and night pain (AOR 2.61 (1.004, 7.39)) best predicted the presence of RCT. A five-point scoring system developed from this model was applied in the remaining patient sample (n = 216) to test validity. No significant differences in performance were noted using ROC curve comparison. Using likelihood ratios, a clinical score = 4 was superior in predicting RCT to the diagnostic prediction of an expert clinician. This score had specificity equivalent to magnetic resonance imaging or ultrasonography in diagnosis of RCT.
The presence of three simple features in the history and physical examination of the shoulder can identify RCT efficiently. This approach offers a valuable strategy to diagnosis at the bedside without compromising sensitivity or specificity.
确定床边病史和体格检查要素在预测老年疑似肩袖撕裂（RCT）患者关节造影结果中的价值。
回顾性图表审查
仅限肩部疾病的骨科诊所
4年期间连续448例疑似RCT并接受关节造影的患者
关节造影显示部分或完全RCT
301例患者（67.2%）有完全或部分RCT证据。单变量分析中与肩袖撕裂最密切相关的临床发现包括冈下肌和冈上肌萎缩（P<0.001）、上举（P<0.001）或外旋（P<0.001）无力、疼痛弧（P=0.004）和撞击征（P=0.01）。基于推导数据集（n=191）的逐步逻辑回归显示，外旋无力（调整优势比（AOR）6.96（3.09，13.03））、年龄≥65岁（AOR 4.05（2.47，16.07））和夜间疼痛（AOR 2.61（1.004，7.39））最能预测RCT的存在。从该模型开发的五分制评分系统应用于其余患者样本（n=216）以测试有效性。使用ROC曲线比较未发现性能有显著差异。使用似然比，临床评分=4在预测RCT方面优于专家临床医生的诊断预测。该评分在RCT诊断中的特异性等同于磁共振成像或超声检查。
肩部病史和体格检查中的三个简单特征可有效识别RCT。这种方法为床边诊断提供了一种有价值的策略，而不会损害敏感性或特异性。
