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Diagnostic tests in the clinical diagnosis of lumbar spinal stenosis: Consensus and Results of an International Delphi Study.
European Spine Journal ( IF 2.8 ) Pub Date : 2020-06-09 , DOI: 10.1007/s00586-020-06481-w
Christy Tomkins-Lane 1 , Markus Melloh 2 , Arnold Wong 3
Affiliation  

Purpose

Reach a consensus on which diagnostic tests are most important in confirming the clinical diagnosis of lumbar spinal stenosis (LSS).

Methods

Phase 1: 22 members of the International Taskforce on the Diagnosis and Management of LSS confirmed 35 diagnostic items. An on-line survey was developed that allows experts to express the logical order in which they consider the diagnostic tests, and the level of certainty ascertained from each test. Phase 2, Round 1: Survey distributed to members of the International Society for the Study of the Lumbar Spine. Round 2: Meeting of 15 members of Taskforce defined final list of 10 items. Round 3: Survey was distributed internationally, followed by Taskforce consensus.

Results

Totally, 432 clinicians from 28 different countries participated. Certainty of the diagnosis was 60% after selecting the first test and significant change in certainty ceasing after eight items at 90.8% certainty (p < 0.05). The most frequently selected tests included MRI/CT scan, neurological examination and walking test with gait observation. The diagnostic test selected most frequently as the first test was neurological examination.

Conclusions

This is the first study to reach an international consensus on which diagnostic tests should be used in the clinical diagnosis of LSS. The final recommendation includes three core diagnostic items: neurological examination, MRI/CT and walking test with gait observation. The Taskforce also recommends 3 ‘rule out’ tests: foot pulses/ABI, hip examination and test for cervical myelopathy. If applied, this core set of diagnostic tests can standardize outcomes and improve clinical care of LSS globally.



中文翻译:

腰椎管狭窄症的临床诊断中的诊断测试:国际德尔菲研究的共识和结果。

目的

在确定腰椎管狭窄症(LSS)的临床诊断中最重要的诊断测试上达成共识。

方法

阶段1:LSS诊断和管理国际工作组的22名成员确认了35个诊断项目。开发了一种在线调查,使专家能够表达他们考虑诊断测试的逻辑顺序以及从每个测试中确定的确定性水平。第二阶段,第1轮:调查已分发给国际腰椎研究学会成员。第2轮:任务组15名成员的会议确定了10个项目的最终清单。第三轮:调查在全球范围内进行,随后获得了工作组的共识。

结果

共有来自28个国家的432名临床医生参加。在选择第一个测试后,诊断的确定性为60%,在八项检查后的确定性显着变化为90.8%(p  <0.05)。选择最频繁的检查包括MRI / CT扫描,神经学检查和步态观察步行检查。诊断检查最常被选择,因为第一项检查是神经系统检查。

结论

这是关于在LSS的临床诊断中应使用诊断测试的国际共识的第一项研究。最终建议包括三个核心诊断项目:神经系统检查,MRI / CT和步态观察步行测试。该工作组还建议进行3种“排除”测试:足部脉冲/ ABI,臀部检查和宫颈脊髓病测试。如果应用,这套核心的诊断测试可以使结果标准化,并在全球范围内改善LSS的临床护理。

更新日期:2020-06-09
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