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Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_6 | Pages 26 - 26
1 Feb 2016
Stynes S Konstantinou K Ogollah R Hay E Dunn K
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Background:. Identification of nerve root involvement (NRI) in patients with low back-related leg pain (LBLP) can be challenging. Diagnostic models have mainly been developed in secondary care with conflicting reference standards and predictor selection. This study aims to ascertain which cluster of items from clinical assessment best identify NRI in primary care consulters with LBLP. Methods:. Cross-sectional data on 395 LBLP consulters were analysed. Potential NRI indicators were seven clinical assessment items. Two definitions of NRI formed the reference standards: (i) high confidence (≥80%) NRI clinical diagnosis (ii) high confidence (≥80%) NRI clinical diagnosis with confirmatory magnetic resonance imaging (MRI) findings. Multivariable logistic regression models were constructed and compared for both reference standards. Model performances were summarised using the Hosmer-Lemeshow statistic and area under the curve (AUC). Bootstrapping assessed internal validity. Results:. NRI clinical diagnosis model retained five items. The model with MRI in the reference standard retained six items. Four items remained in both models: below knee pain, leg pain worse than back pain, positive neural tension tests, neurological deficit (myotome, reflex or sensory). NRI clinical diagnosis model was well calibrated (p=0.17) and discrimination was AUC 0.96 (95%CI: 0.93, 0.98). Performance measures for clinical diagnosis plus confirmatory MRI model showed good discrimination (AUC 0.83, 95% CI: 0.78, 0.86) but poor calibration (p=0.01). Bootstrapping revealed minimal overfitting in both models. Conclusion:. A cluster of items identified NRI in LBLP consulters. These criteria could be used clinically and in research to improve accuracy of identification and homogeneity of this subgroup of low back pain patients


The Bone & Joint Journal
Vol. 104-B, Issue 1 | Pages 97 - 102
1 Jan 2022
Hijikata Y Kamitani T Nakahara M Kumamoto S Sakai T Itaya T Yamazaki H Ogawa Y Kusumegi A Inoue T Yoshida T Furue N Fukuhara S Yamamoto Y

Aims

To develop and internally validate a preoperative clinical prediction model for acute adjacent vertebral fracture (AVF) after vertebral augmentation to support preoperative decision-making, named the after vertebral augmentation (AVA) score.

Methods

In this prognostic study, a multicentre, retrospective single-level vertebral augmentation cohort of 377 patients from six Japanese hospitals was used to derive an AVF prediction model. Backward stepwise selection (p < 0.05) was used to select preoperative clinical and imaging predictors for acute AVF after vertebral augmentation for up to one month, from 14 predictors. We assigned a score to each selected variable based on the regression coefficient and developed the AVA scoring system. We evaluated sensitivity and specificity for each cut-off, area under the curve (AUC), and calibration as diagnostic performance. Internal validation was conducted using bootstrapping to correct the optimism.