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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >NUMERICAL RATING SCALE AS A PREDICTOR OF AN UNDERLYING PATHOLOGY IN PEDIATRIC BACK PAIN USING MAGNETIC RESONANCE IMAGE AS DIAGNOSTIC TOOL
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NUMERICAL RATING SCALE AS A PREDICTOR OF AN UNDERLYING PATHOLOGY IN PEDIATRIC BACK PAIN USING MAGNETIC RESONANCE IMAGE AS DIAGNOSTIC TOOL

机译：数值评级规模作为使用磁共振图像作为诊断工具的儿科背部疼痛潜在病理的预测因子

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Background & Objectives: Recently, constant and night pain has been discarded as adequate clinical markers to predict the presence of an underlying pathology in pediatric back pain. The pain intensity has been recognized as an important domain in the pain assessment. Numerical Rating Scale (NRS) is one of the most common validated tools to assess pediatric pain intensity in children above 8 years of age. The aim of this study is to assess NRS as a predictor of underlying pathologies found by magnetic resonance image (MRI) in pediatric back pain. We hypothesize that a higher NRS score is associated with a high sensitivity, specificity and likelihood ratio to identify the present of organic pathology in pediatric chronic back pain. Methodology: After obtaining Institutional Review Board approval, a retrospective electronical medical record review was conducted. All pediatric patients who reported back pain lasting & 4 weeks between 2009 to 2018 were enrolled in the study. As per regular protocol, a pediatric orthopedic surgeon evaluated all patients who presented with back pain. After a non-diagnostic history, physical examination and spinal x-ray; spine MRI was order. Pain was graded with the use of NRS from 0 to 10. Patients were divided in two groups: NRS (1-5) & NRS (6-10). Variables such as gender, age, pain frequency, night pain, neurological exam, and the presence of an underlying pathology were compared between both groups. Patients that presented with injury due to trauma, previous diagnosis of back pain or cervical pain were excluded. Results: A total of 467 patients were evaluated in the study. Mean age of subjects was 15 years; 69% being female. An underlying pathology was identified in 131/315 (41.6%) patients with NRS (6-10), and 55/152 (36.2%) patients with NRS (1-5) (P=0.27). Patients with NRS (6-10) had two times more probability of suffering constant pain (P&0.03) and three times more likely of having an abnormal neurological examination (P&0.05). See table 1. Conclusion: Evaluation and treatment of children and adolescent with chronic back pain is challenging. Our study shows a strong association between NRS high (6-10) and constant pain and/or abnormal neurological exam. However, the use of NRS of (6-10) was not found as adequate predictor for the presence of an underlying organic pathology in children and adolescent patients. Therefore, physicians should not rely only high NRS score to recommend advance imaging study to assess chronic back pain in children and adolescent patients.
机译：背景＆amp;目的：最近，常数和夜间疼痛被丢弃为适当的临床标记，以预测小儿背部疼痛的潜在病理的存在。疼痛强度被认为是疼痛评估中的重要领域。数值评级规模（NRS）是最常见的验证工具之一，以评估8岁以上儿童的儿科疼痛强度。本研究的目的是评估NRS作为磁共振图像（MRI）在儿科背部疼痛中发现的潜在病理的预测因子。我们假设较高的NRS分数与高灵敏度，特异性和似然比相关的，以识别小儿慢性背部疼痛的有机病理学的目的。方法论：在获得机构审查委员会批准后，进行了回顾性电子医疗记录审查。所有报告痛苦持久的儿科患者持久＆amp; 2009年至2018年间4周读入该研究。根据常规方案，儿科骨科外科医生评估所有提出背痛的患者。经过非诊断历史，体检和脊柱X射线;脊柱MRI是命令。使用NRS从0到10中使用疼痛。患者分为两组：NRS（1-5）＆amp; NRS（6-10）。在两组之间比较了两组性别，年龄，疼痛频率，夜间疼痛，神经检查和潜在病理学的变量。由于创伤引起的伤害而提出的患者，以前的诊断疼痛或宫颈疼痛被排除在外。结果：在该研究中共评估了467名患者。受试者的平均年龄为15年; 69％是女性。 131/315（41.6％）NRS（6-10）患者鉴定了潜在的病理学，55/152（36.2％）NRS（1-5）患者（p = 0.27）。患有NRS（6-10）的患者的患者持续疼痛（P＆amp; 0.03）的概率更高，具有异常神经检查（P＆amp; 0.05）的可能性更容易出现三倍。见表1.结论：慢性背部疼痛的儿童和青少年的评估和治疗是挑战性的。我们的研究表明，NRS高（6-10）和恒定的疼痛和/或神经检查异常之间的强烈关联。然而，没有发现（6-10）的NRS是适当的预测因子，用于儿童和青少年患者的潜在有机病理学存在。因此，医生不应该只依赖于高位NRS得分来推荐预先成像研究，以评估儿童和青少年患者的慢性背痛。

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