通过病史采集评估腰骶神经根受压的诊断准确性。
Diagnostic accuracy of history taking to assess lumbosacral nerve root compression.
作者信息
Verwoerd Annemieke J H, Peul Wilco C, Willemsen Sten P, Koes Bart W, Vleggeert-Lankamp Carmen L A M, el Barzouhi Abdelilah, Luijsterburg Pim A J, Verhagen Arianne P
机构信息
Department of General Practice, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Department of Neurosurgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands; Medical Center Haaglanden, PO Box 432, 2501 CK The Hague, The Netherlands.
出版信息
Spine J. 2014 Sep 1;14(9):2028-37. doi: 10.1016/j.spinee.2013.11.049. Epub 2013 Dec 8.
BACKGROUND CONTEXT
The diagnosis of sciatica is primarily based on history and physical examination. Most physical tests used in isolation show poor diagnostic accuracy. Little is known about the diagnostic accuracy of history items.
PURPOSE
To assess the diagnostic accuracy of history taking for the presence of lumbosacral nerve root compression or disc herniation on magnetic resonance imaging in patients with sciatica.
STUDY DESIGN
Cross-sectional diagnostic study.
PATIENT SAMPLE
A total of 395 adult patients with severe disabling radicular leg pain of 6 to 12 weeks duration were included.
OUTCOME MEASURES
Lumbosacral nerve root compression and disc herniation on magnetic resonance imaging were independently assessed by two neuroradiologists and one neurosurgeon blinded to any clinical information.
METHODS
Data were prospectively collected in nine hospitals. History was taken according to a standardized protocol. There were no study-specific conflicts of interest.
RESULTS
Exploring the diagnostic odds ratio of 20 history items revealed a significant contribution in diagnosing nerve root compression for "male sex," "pain worse in leg than in back," and "a non-sudden onset." A significant contribution to the diagnosis of a herniated disc was found for "body mass index <30," "a non-sudden onset," and "sensory loss." Multivariate logistic regression analysis of six history items pre-selected from the literature (age, gender, pain worse in leg than in back, sensory loss, muscle weakness, and more pain on coughing/sneezing/straining) revealed an area under the receiver operating characteristic curve of 0.65 (95% confidence interval, 0.58-0.71) for the model diagnosing nerve root compression and an area under the receiver operating characteristic curve of 0.66 (95% confidence interval, 0.58-0.74) for the model diagnosing disc herniation.
CONCLUSIONS
A few history items used in isolation had significant diagnostic value and the diagnostic accuracy of a model with six pre-selected items was poor.
背景信息
坐骨神经痛的诊断主要基于病史和体格检查。多数单独使用的体格检查方法诊断准确性欠佳。关于病史项目的诊断准确性，人们所知甚少。
目的
评估坐骨神经痛患者病史采集对于磁共振成像显示的腰骶神经根受压或椎间盘突出的诊断准确性。
研究设计
横断面诊断性研究。
患者样本
共纳入395例成年患者，其严重致残性腿部放射性疼痛持续6至12周。
观察指标
两名神经放射科医生和一名神经外科医生在不知任何临床信息的情况下，独立评估磁共振成像显示的腰骶神经根受压和椎间盘突出情况。
方法
在9家医院前瞻性收集数据。按照标准化方案采集病史。不存在与研究相关的利益冲突。
结果
探究20项病史项目的诊断比值比发现，“男性”“腿部疼痛比背部更严重”以及“非突发起病”对神经根受压的诊断有显著贡献。“体重指数<30”“非突发起病”以及“感觉丧失”对椎间盘突出的诊断有显著贡献。对从文献中预先选择的6项病史项目（年龄、性别、腿部疼痛比背部更严重、感觉丧失、肌肉无力以及咳嗽/打喷嚏/用力时疼痛加重）进行多变量逻辑回归分析显示，诊断神经根受压模型的受试者工作特征曲线下面积为0.65（95%置信区间，0.58 - 0.71），诊断椎间盘突出模型的受试者工作特征曲线下面积为0.66（95%置信区间，0.58 - 0.74）。
结论
单独使用的少数病史项目具有显著诊断价值，且包含6项预先选择项目的模型诊断准确性欠佳。
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