INAPPROPRIATE MRI USE IN THE DIAGNOSIS OF ACUTE SCIATICA
Notice bibliographique
Résumé
Magnetic resonance imaging (MRI) is a resource that warrants judicious use in Canada. Sciatica is a painful and debilitating condition resulting from compression (often from a herniated disc) of lumbosacral nerve roots. For most patients, this condition is self-limiting and resolves within 6 to 12 weeks. Given the high sensitivity and specificity of the diagnosis based on patient history and physical exam (90% and 71%, respectively), many would argue that MRI is not necessary in the diagnosis of acute sciatica. The goal of this study was to identify the incidence of MRI use in patients from an acute sciatica clinic, and then to elucidate any cost and time savings that could be realized by more appropriate MRI allocation. Patients were referred primarily from the emergency department and from primary care, after meeting our set inclusion criteria. All patients were seen within 4 weeks of their first presentation of sciatica, and were seen and assessed by a spine surgeon in our acute sciatica clinic. Incidence of MRI use in surgical and non-surgical patients was calculated. Of 128 patients enrolled in our study, 15 (12%) required surgical intervention while 113 (88%) experienced spontaneous resolution of their sciatica. Of the 113 patients that experienced spontaneous resolution, 49 (43.5%) received an MRI. Further to this, 11 (9%) non-surgical patients received an additional MRI. Understandably, 15 (100%) of surgical patients received an MRI. However, within the surgical population 7 (47%) patients received an additional MRI prior to surgery. Given the cost-estimate of $750CDN per MRI, $50,250 was the total cost for these 67 MRIs. No patients became surgical as a result of MRI findings. It is apparent that a large proportion of our patients, both surgical and nonsurgical, may have received an unnecessary MRI. Specifically, there were up to 67 potentially unnecessary MRIs conducted within just 128 patients in this study. The patients in this study met the inclusion criteria with a high sensitivity and specificity for sciatica, and in the absence of other spinal conditions. While some MRI usage in this non-surgical population may have been warranted, it is unlikely that the significant number of scans are justifiable. In a conservative cost estimate (excluding time in scanner, tech time, and radiologist time), $50,250.00 could have been saved. It is unclear what leads to the overuse of MRI in the work up for acute sciatica. Perhaps diagnostic uncertainty in some referring doctors is contributing. This study suggests that a clinic dedicated to the treatment of acute sciatica could have immediate benefits in health care resource allocation.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».