title: Development of a clinical diagnosis support tool to identify patients with lumbar spinal stenosis.
abstract: No clinical diagnostic support tool can help identify patients with LSS. Simple diagnostic tool may improve the accuracy of the diagnosis of LSS. The aim of this study was to develop a simple clinical diagnostic tool that may help physicians to diagnose LSS in patients with lower leg symptoms. Patients with pain or numbness of the lower legs were prospectively enrolled. The diagnosis of LSS by experienced orthopedic specialists was the outcome measure. Multivariable logistic regression analysis identified factors that predicted LSS; a simple clinical prediction rule was developed by assigning a risk score to each item based on the estimated beta-coefficients. From December 2002 to December 2004, 104 orthopedic physicians from 22 clinics and 50 hospitals evaluated 468 patients. Two items of physical examination, three items of patients' symptom, and five items of physical examination were included in the final scoring system as a result of multiple logistic regression analysis. The sum of the risk scores for each patient ranged from -2 to 16. The Hosmer-Lemeshow statistic was 11.30 (P = 0.1851); the area under the ROC curve was 0.918. The clinical diagnostic support tool had a sensitivity of 92.8% and a specificity of 72.0%. The prevalence of LSS was 6.3% in the bottom quartile of the risk score (-2 to 5) and 99.0% in the top quartile (12 to 16). We developed a simple clinical diagnostic support tool to identify patients with LSS. Further studies are needed to validate this tool in primary care settings.
authors.affiliation: Department of Orthopaedic Surgery, Fukuhsima Medical University, Hikarigaoka 1, Fukushima, 960-1295, Japan. skonno@fmu.ac.jp
authors.forename: Shinichi
authors.initials: S
authors.lastname: Konno
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Hayashino
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kikuchi
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kaneda
authors.forename: Atsushi
authors.initials: A
authors.lastname: Seichi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Chiba
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Satomi
authors.forename: Kensei
authors.initials: K
authors.lastname: Nagata
authors.forename: Shinya
authors.initials: S
authors.lastname: Kawai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D019937:Diagnostic Techniques and Procedures; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012985:Software Design; D013130:Spinal Stenosis / Q000175:diagnosis* / Q000453:epidemiology