title: Potential triaging of referrals for lumbar spinal surgery consultation: a comparison of referral accuracy from pain specialists, findings from advanced imaging and a 3-item questionnaire.
abstract: BACKGROUND
  Waiting times to see a spinal surgeon are among the highest in Canada. However, most patients who are referred would not benefit from surgical care. Effective triaging of surgical candidates may reduce morbidity related to prolonged waiting times and optimize use of limited resources.
  
  
  METHODS
  We administered a questionnaire consisting of 3 items identifying leg-dominant or back-dominant pain among 119 consecutive patients who presented at a community spinal pain centre or a spinal surgical unit for assessment of an elective lumbar problem. We analyzed the questionnaire under 2 different scenarios: 1 hypothesized to be more sensitive and 1 hypothesized to be more specific.
  
  
  RESULTS
  For the "sensitive" scenario of clearly back-dominant pain, the sensitivity of the questionnaire was 100% in identifying appropriate surgical candidates. For the "specific" scenario of leg-dominant pain, the questionnaire had a sensitivity of 83% and specificity of 73% in identifying appropriate surgical candidates, which was significantly superior to findings on computed tomography or magnetic resonance imaging (i.e., presence of neurocompressive lesions). When comparing the accuracy of the questionnaire in identifying appropriate surgical candidates to that of an assessment performed by a pain specialist at an acute spinal pain clinic, we found no statistically significant differences between the 2 methods.
  
  
  CONCLUSIONS
  Use of the questionnaire when triaging patients may decrease the number of unnecessary referrals to spine surgeons. Adopting such a method of triaging could reduce waiting times for appropriate surgical candidates and potentially improve the outcomes of any resulting spinal surgery performed in a timely fashion.
authors.affiliation: Division of Orthopedic Surgery, University of Ottawa, Ottawa, Ont.
authors.forename: David
authors.initials: D
authors.lastname: Simon
authors.forename: Matt
authors.initials: M
authors.lastname: Coyle
authors.forename: Simon
authors.initials: S
authors.lastname: Dagenais
authors.forename: Joseph
authors.initials: J
authors.lastname: O'Neil
authors.forename: Eugene K
authors.initials: EK
authors.lastname: Wai
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000209:etiology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014218:Triage; D014850:Waiting Lists