Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA; School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.
Spine J. 2019 Feb;19(2):293-300. doi: 10.1016/j.spinee.2018.06.342. Epub 2018 Jun 26.
Red flags are questions typically ascertained by providers to screen for serious underlying spinal pathologies. The utility of patient-reported red flags in guiding clinical decision-making for spine care, however, has not been studied.
The aim of this study was to quantify the sensitivity and specificity of patient-reported red flags in predicting the presence of serious spinal pathologies.
This was a retrospective nested case-control study.
This study consisted of 120 patients with International Classification of Diseases, Ninth Revision, Clinical Modification codes for spinal pathologies and 380 randomly selected patients, from a population of 4,313 patients seen at a large tertiary care spine clinic between October 9, 2013 and June 30, 2014.
The presence of patient-reported red flags and red flags obtained from medical records was verified for chart review. The spinal pathology (ie, malignancy, fractures, infections, or cauda equina syndrome) was noted for each patient.
The sensitivity and specificity of patient-reported red flags for detecting serious spinal pathologies were calculated from data obtained from the 500 patients. Youden's J was used to rank performance. Agreement between patient-reported red flags and those obtained from medical record review was assessed via Cohen's kappa statistic.
"History of cancer" was the best performing patient-reported red flag to identify malignancy (sensitivity=0.75 [95% confidence intervals, CI 0.53-0.90], specificity=0.79 [95% CI 0.75-0.82]). The best performing patient-reported red flag for fractures was the presence of at least one of the following: "Osteoporosis," "Steroid use," and "Trauma" (sensitivity=0.59 [95% CI 0.44-0.72], specificity=0.65 [95% CI 0.60-0.69]). The prevalence of infection and cauda equina diagnoses was insufficient to gauge sensitivity and specificity. Red flags from medical records had better performance than patient-reported red flags. There was poor agreement between patient red flags and those obtained from medical record review.
Patient-reported red flags had low sensitivity and specificity for identification of serious pathologies. They should not be used in insolation to make treatment decisions, although they may be useful to prompt further probing to determine if additional investigation is warranted.
红色标记是医生通常用来筛查严重脊柱潜在疾病的问题。然而，患者报告的红色标记在指导脊柱护理的临床决策方面的效用尚未得到研究。
本研究旨在定量评估患者报告的红色标记在预测严重脊柱病变中的敏感性和特异性。
这是一项回顾性巢式病例对照研究。
这项研究包括 120 名患有国际疾病分类，第九版，临床修正代码的脊柱疾病患者和 380 名随机选择的患者，他们来自 2013 年 10 月 9 日至 2014 年 6 月 30 日期间在一家大型三级护理脊柱诊所就诊的 4313 名患者中的一部分。
通过病历审查对患者报告的红色标记和从病历中获得的红色标记的存在进行了验证。记录了每位患者的脊柱病变（即恶性肿瘤、骨折、感染或马尾综合征）。
从 500 名患者的数据中计算了患者报告的红色标记用于检测严重脊柱病变的敏感性和特异性。使用 Youden's J 来对性能进行排名。通过 Cohen's kappa 统计评估患者报告的红色标记与从病历审查中获得的红色标记之间的一致性。
“癌症史”是识别恶性肿瘤的表现最佳的患者报告的红色标记（敏感性=0.75[95%置信区间，CI 0.53-0.90]，特异性=0.79[95%CI 0.75-0.82]）。用于骨折的表现最佳的患者报告的红色标记是存在以下至少一种情况：“骨质疏松症”、“类固醇使用”和“创伤”（敏感性=0.59[95%CI 0.44-0.72]，特异性=0.65[95%CI 0.60-0.69]）。感染和马尾综合征诊断的患病率不足以评估敏感性和特异性。病历中的红色标记比患者报告的红色标记具有更好的性能。患者的红色标记与从病历审查中获得的红色标记之间的一致性较差。
患者报告的红色标记对识别严重病变的敏感性和特异性较低。它们不应单独用于做出治疗决策，尽管它们可能有助于提示进一步探究以确定是否需要进一步检查。
