Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compression
Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compression
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DOI：
10.1136/jnnp.72.5.630
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发表时间：
2002-05-01
影响因子：
11
通讯作者：
Knottnerus, JA
中科院分区：
文献类型：
--
作者：
Vroomen, PCAJ;de Krom, MCTFM;Knottnerus, JA
目标：目的探讨腰骶神经根受压致坐骨神经痛的临床诊断中患者的特征、症状和检查结果。所有患者均接受了标准化的临床评估和磁共振（MR）成像。患者的特点，临床表现，和腰骶神经根压缩MR imaging.Results之间的关联进行了分析：神经根压缩与三个病人的特点，三个症状，和四个体检结果（轻瘫，没有肌腱反射，一个积极的直腿抬高试验，并增加手指地板距离）。多变量分析，分析测试的独立诊断价值，表明神经根压迫是由两个病人的特点，四个症状，和两个迹象（增加指底距离和轻瘫）预测。直腿抬高试验没有预测性。受试者工作特征曲线下的面积为0.80的历史项目。增加体检项目后，增加至0.83。结论：MR成像发现多种临床表现与神经根受压有关。虽然这组发现与日常实践中常用的结果一致，但这些测试的灵敏度和特异性往往低于以前的报道。多因素逐步分析显示，体格检查所揭示的诊断信息大部分已被病史项目所揭示。
Objective: To evaluate patient characteristics, symptoms, and examination findings in the clinical diagnosis of lumbosacral nerve root compression causing sciatica.Methods: The study involved 274 patients with pain radiating into the leg. All had a standardised clinical assessment and magnetic resonance (MR) imaging. The associations between patient characteristics, clinical findings, and lumbosacral nerve root compression on MR imaging were analysed.Results: Nerve root compression was associated with three patient characteristics, three symptoms, and four physical examination findings (paresis, absence of tendon reflexes, a positive straight leg raising test, and increased finger-floor distance). Multivariate analysis, analysing the independent diagnostic value of the tests, showed that nerve root compression was predicted by two patient characteristics, four symptoms, and two signs (increased finger-floor distance and paresis). The straight leg raise test was not predictive. The area under the curve of the receiver-operating characteristic was 0.80 for the history items. It increased to 0.83 when the physical examination items were added.Conclusions: Various clinical findings were found to be associated with nerve root compression on MR imaging. While this set of findings agrees well with those commonly used in daily practice, the tests tended to have lower sensitivity and specificity than previously reported. Stepwise multivariate analysis showed that most of the diagnostic information revealed by physical examination findings had already been revealed by the history items.