Predictive value of self-reported patient information for the identification of lumbar spinal stenosis.
BACKGROUND
To our knowledge, no objective criterion has been identified for the diagnosis of lumbar spinal stenosis (LSS) and no study has evaluated the predictive value of self-reported patient information for the identification of LSS.


OBJECTIVE
To develop and validate a prediction rule for the identification of LSS based on self-reported patient information alone.


METHODS
Prospective derivation study using a coefficient-based multivariable logistic regression scoring method with internal validation with primary care clinics and orthopaedic departments of medical centres, as well as university and other hospitals. Participants were consecutive patients with primary symptoms of pain or numbness in the lower extremities. Physician-diagnosed LSS was the


METHODS



RESULTS
Of 468 patients included in the analysis, 47.3% were diagnosed with LSS and divided into derivation and validation sets. The following items were retained at the conclusion of the derivation process: age (<60, 60-70 and >70), duration of symptoms over 6 months, symptom improvement when bending forward, symptom improvement when bending backward, symptom exacerbation while standing up, intermittent claudication and urinary incontinence. To derive a risk score for each patient, integer-based scores were assigned and summed. In the validation data sets, prevalence of LSS in patients from the first to fourth risk score quartile were 13.3%, 47.6%, 55.2% and 65.5%, respectively. Further, the likelihood ratio in the low-risk category was 0.154.


CONCLUSIONS
We developed a prediction rule for the identification of LSS based on self-reported patient information alone. Further, the likelihood ratio in the low-risk category was sufficiently low. This rule may be used for screening of LSS.
Department of Epidemiology and Health Care Research, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Takashi
T
Sugioka
Yasuaki
Y
Hayashino
Shinichi
S
Konno
Shinichi
S
Kikuchi
Shunichi
S
Fukuhara
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000473:pathology*; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D015999:Multivariate Analysis; D010808:Physical Examination; D011237:Predictive Value of Tests; D011859:Radiography; D015203:Reproducibility of Results; D012650:Self Disclosure; D013130:Spinal Stenosis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging