title: Diagnostic accuracy of history taking to assess lumbosacral nerve root compression.
abstract: BACKGROUND
  The diagnosis of sciatica is primarily based on history and physical examination. Most physical tests used in isolation show poor diagnostic accuracy. Little is known about the diagnostic accuracy of history items.
  
  
  OBJECTIVE
  To assess the diagnostic accuracy of history taking for the presence of lumbosacral nerve root compression or disc herniation on magnetic resonance imaging in patients with sciatica.
  
  
  METHODS
  Cross-sectional diagnostic study.
  
  
  METHODS
  A total of 395 adult patients with severe disabling radicular leg pain of 6 to 12 weeks duration were included.
  
  
  METHODS
  Lumbosacral nerve root compression and disc herniation on magnetic resonance imaging were independently assessed by two neuroradiologists and one neurosurgeon blinded to any clinical information.
  
  
  METHODS
  Data were prospectively collected in nine hospitals. History was taken according to a standardized protocol. There were no study-specific conflicts of interest.
  
  
  RESULTS
  Exploring the diagnostic odds ratio of 20 history items revealed a significant contribution in diagnosing nerve root compression for "male sex," "pain worse in leg than in back," and "a non-sudden onset." A significant contribution to the diagnosis of a herniated disc was found for "body mass index <30," "a non-sudden onset," and "sensory loss." Multivariate logistic regression analysis of six history items pre-selected from the literature (age, gender, pain worse in leg than in back, sensory loss, muscle weakness, and more pain on coughing/sneezing/straining) revealed an area under the receiver operating characteristic curve of 0.65 (95% confidence interval, 0.58-0.71) for the model diagnosing nerve root compression and an area under the receiver operating characteristic curve of 0.66 (95% confidence interval, 0.58-0.74) for the model diagnosing disc herniation.
  
  
  CONCLUSIONS
  A few history items used in isolation had significant diagnostic value and the diagnostic accuracy of a model with six pre-selected items was poor.
authors: Department of General Practice, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: j.verwoerd@erasmusmc.nl.
authors: Annemieke J H
authors: AJ
authors: Verwoerd
authors: Department of Neurosurgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands; Medical Center Haaglanden, PO Box 432, 2501 CK The Hague, The Netherlands.
authors: Wilco C
authors: WC
authors: Peul
authors: Department of Biostatistics, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors: Sten P
authors: SP
authors: Willemsen
authors: Department of General Practice, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors: Bart W
authors: BW
authors: Koes
authors: Department of Neurosurgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors: Carmen L A M
authors: CL
authors: Vleggeert-Lankamp
authors: Department of Neurosurgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors: Abdelilah
authors: A
authors: el Barzouhi
authors: Department of General Practice, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors: Pim A J
authors: PA
authors: Luijsterburg
authors: Department of General Practice, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors: Arianne P
authors: AP
authors: Verhagen
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis*; D016015:Logistic Models; D008161:Lumbosacral Region; D008279:Magnetic Resonance Imaging; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D015999:Multivariate Analysis; D018908:Muscle Weakness; D011446:Prospective Studies; D012372:ROC Curve; D011843:Radiculopathy / Q000175:diagnosis* / Q000209:etiology; D012585:Sciatica / Q000175:diagnosis*; D012678:Sensation Disorders / Q000175:diagnosis* / Q000209:etiology; D012737:Sex Factors
keywords: Diagnosis; Disc herniation; Magnetic resonance imaging; Medical history taking; Nerve root compression; Sciatica; Sensitivity; Specificity