Ackerman S J, Steinberg E P, Bryan R N, BenDebba M, Long D M
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Spine (Phila Pa 1976). 1997 Jul 15;22(14):1634-40; discussion 1641. doi: 10.1097/00007632-199707150-00021.
Post hoc analysis of data from the National Low Back Pain Study, a prospective observational multicenter study of patients referred for the evaluation and treatment of persistent low back problems.
To identify patient characteristics associated with use of particular diagnostic imaging examinations in patients with persistent low back problems.
The Agency for Health Care Policy and Research clinical practice guidelines on low back problems suggest that the use of particular diagnostic imaging tests for a given patient should be based on specific characteristics of that patient.
Use of diagnostic imaging examinations in 2,374 patients with persistent low back problems who were enrolled in the National Low Back Pain Study from 1986 to 1991 was analyzed. Stepwise logistic regression was used to identify patient characteristics that distinguish between enrollees who underwent particular imaging studies.
Characteristics that distinguished patients who had undergone magnetic resonance imaging from those who had received only lumbo-sacral spine radiographs included higher socioeconomic status, greater resource use in the preceding 12 months, more functional impairment, presence of sciatica, and presence of neurologic signs/symptoms suggestive of nerve root compromise. Suspected soft tissue involvement was characteristic of enrollees who had undergone magnetic resonance imaging, whereas suspected structural involvement characterized patients who received noncontrast computed tomography. Only nonclinical factors, such as higher annual household income, disability compensation, and male gender distinguished enrollees who had undergone both magnetic resonance imaging and computed tomography-myelography from those who received only computed tomography-myelography.
Particular patient socioeconomic and clinical characteristics are associated with receipt of specific imaging studies in evaluation of persistent low back problems.
对国家腰痛研究的数据进行事后分析，该研究是一项对因持续性腰痛问题前来评估和治疗的患者进行的前瞻性观察性多中心研究。
确定与持续性腰痛问题患者使用特定诊断性影像学检查相关的患者特征。
医疗保健政策与研究机构关于腰痛问题的临床实践指南表明，针对特定患者使用特定诊断性影像学检查应基于该患者的具体特征。
分析了1986年至1991年纳入国家腰痛研究的2374例持续性腰痛问题患者的诊断性影像学检查使用情况。采用逐步逻辑回归来确定区分接受特定影像学检查的受试者的患者特征。
将接受磁共振成像的患者与仅接受腰骶部脊柱X光片检查的患者区分开来的特征包括较高的社会经济地位、前12个月更多的资源使用、更多的功能障碍、坐骨神经痛的存在以及提示神经根受压的神经体征/症状的存在。疑似软组织受累是接受磁共振成像的受试者的特征，而疑似结构受累是接受非增强计算机断层扫描的患者的特征。只有非临床因素，如较高的家庭年收入、残疾赔偿金和男性性别，将同时接受磁共振成像和计算机断层扫描脊髓造影的受试者与仅接受计算机断层扫描脊髓造影的受试者区分开来。
在评估持续性腰痛问题时，特定的患者社会经济和临床特征与接受特定的影像学检查相关。
