Hospital for Sick Children, 555 University Avenue, Room S229, Toronto, ON M5G 1X8, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Eur Spine J. 2024 Oct;33(10):3776-3783. doi: 10.1007/s00586-024-08389-1. Epub 2024 Jul 17.
The study aims to establish the diagnostic accuracy of community spine x-rays for brace candidates.
A review of adolescent idiopathic scoliosis patients seen for initial visit at a tertiary care pediatric hospital was conducted (n = 170). The index test was the pre-referral community spine x-ray interpreted by a community radiologist. Measures of diagnostic accuracy for the index test were determined against the reference standard if images were obtained within 90 days (n = 111). The reference standard was the 3-foot standing EOS spine x-ray evaluated by spine specialists. Diagnostic criterion for a brace candidate was dichotomized by Cobb angle range (25-40°) according to Scoliosis Research Society criteria. Risser stage was not included given significant missing data in index reports. To mitigate the uncertainty around true progression, sensitivity analyses were conducted on a sub-sample of data when index test was within 60 days of the reference standard (n = 67).
Accuracy of the community spine x-ray to detect a brace candidate was 65.8% (95% CI 56.2-74.5). Sensitivity of the index test was 65.4% with a false negative rate of 34.6%. Specificity was 66.1% with a false positive rate of 33.9%. Positive and negative predictive values were 63.0% and 68.4%, respectively. Of the total number of brace candidates (n = 52), 32.7% were missed because of underestimation in Cobb angle (95% CI 21.5-46.2). The proportion of missed brace candidates because of underestimation was unchanged with 60-day data (p = 0.37).
Inaccuracies in community spine radiology may lead to missed opportunities for non-operative treatment.
本研究旨在确定社区脊柱 X 光片在支具候选者中的诊断准确性。
对在三级儿科医院就诊的青少年特发性脊柱侧凸患者进行了回顾性研究（n=170）。本研究的指标检测是社区放射科医生解读的社区脊柱 X 光片。如果在 90 天内获得图像（n=111），则根据参考标准确定对指标检测的诊断准确性。参考标准是脊柱专家评估的 3 英尺站立位 EOS 脊柱 X 光片。根据 SRS 标准，支具候选者的诊断标准通过 Cobb 角范围（25-40°）进行二分类。由于索引报告中存在大量缺失数据，因此未包括 Risser 分期。为了减轻真正进展的不确定性，当指标测试在参考标准的 60 天内（n=67）时，对数据的子样本进行了敏感性分析。
社区脊柱 X 光片检测支具候选者的准确性为 65.8%（95%CI 56.2-74.5）。该指标测试的敏感性为 65.4%，假阴性率为 34.6%。特异性为 66.1%，假阳性率为 33.9%。阳性和阴性预测值分别为 63.0%和 68.4%。在总支具候选者人数中（n=52），由于 Cobb 角低估（95%CI 21.5-46.2），有 32.7%的患者被漏诊。60 天数据的低估漏诊支具候选者的比例不变（p=0.37）。
社区脊柱放射学的不准确可能导致错失非手术治疗的机会。
