Diagnostic evaluation of low back pain with emphasis on imaging
Diagnostic evaluation of low back pain with emphasis on imaging
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DOI：
10.7326/0003-4819-137-7-200210010-00010
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发表时间：
2002-10-01
影响因子：
39.2
通讯作者：
Deyo, RA
中科院分区：
文献类型：
--
作者：
Jarvik, JG;Deyo, RA
目的：回顾基层医疗机构中腰痛患者临床信息和影像学诊断准确性的证据。数据来源：MEDLINE检索（1966年1月至2001年9月）的文章和评论相关的准确性的临床和放射学检查的患者腰痛。研究选择：作者根据综合判断审查了摘要和选定的文献。临床检查的数据主要基于最近的系统评价;影像学检查的数据主要基于原始文献。数据提取：诊断结果由一位或另一位作者提取。对方法的质量进行了非正式评价。主要潜在的偏见被确定，但既没有定量数据提取，也没有scoring.Data合成：正式的荟萃分析没有使用，因为诊断的硬件和软件，金标准，和病人的选择方法是异质性和研究的数量很少。磁共振成像（0.83至0.93）和放射性核素扫描（0.74至0.98）对癌症的敏感性最高;磁共振成像的特异性最高（0.9至0.97）。X线（0.95 ~ 0.99）。磁共振成像是最敏感（0.96）和特异性（0.92）感染的测试。磁共振成像椎间盘突出的敏感性和特异性略高于计算机断层扫描，但非常相似的诊断脊柱狭窄'. Conclusions：数据表明，诊断策略类似于1994年机构的卫生保健政策和研究指南。对于年龄小于50岁且无全身性疾病体征或症状的成年人，不进行影像学检查的对症治疗是合适的。对于50岁及以上的患者或那些发现提示全身性疾病的患者，平片和简单的实验室检查几乎可以完全排除潜在的全身性疾病。对于考虑手术或强烈怀疑有全身性疾病的患者，应保留先进的影像学检查。
Purpose: To review evidence on the diagnostic accuracy of clinical information and imaging for patients with low back pain in primary care settings.Data Source: MEDLINE search (January 1966 to September 2001) for articles and reviews relevant to the accuracy of the clinical and radiographic examination of patients with low back pain.Study Selection: The authors reviewed abstracts and selected articles for review on the basis of a combined judgment. Data on the clinical examination were based primarily on recent systematic reviews; data on imaging tests were based primarily on original articles.Data Extraction: Diagnostic results were extracted by one or the other author. Quality of methods was evaluated informally. Major potential biases were identified, but neither quantitative data extraction nor scoring was done.Data Synthesis: Formal meta-analysis was not used because the diagnostic hardware and software, gold standards, and patient selection methods were heterogeneous and the number of studies was small. Sensitivity for cancer was highest for magnetic resonance imaging (0.83 to 0.93) and radionuclide scanning (0.74 to 0.98); specificity was highest for magnetic resonance imaging (0.9 to 0.97.) and radiography (0.95 to 0.99). Magnetic resonance imaging was the most sensitive (0.96) and specific (0.92) test for infection. The sensitivity and specificity of magnetic resonance imaging for herniated discs were slightly higher than those for computed tomography but very similar for the diagnosis of spinal stenosis'.Conclusions: The data suggest a diagnostic strategy similar to the 1994 Agency for Health Care Policy and Research guidelines. For adults younger than 50 years of age with no signs or symptoms of systemic disease, symptomatic therapy without imaging is appropriate. For patients 50 years of age and older or those whose findings suggest systemic disease, plain radiography and simple laboratory tests can almost completely rule out underlying systemic diseases. Advanced imaging should be reserved I for patients who are considering surgery or those in whom systemic disease is strongly suspected.