Efficiency of telephone triage in the assessment of low back pain at a tertiary spine clinic
Bibliographic record
Abstract
PURPOSE: In response to COVID-19 related health care access restrictions, telemedicine was introduced to continue to provide necessary health care access in Ontario, Canada. This study examined the role of a telephone assessment (triage) in streamlining referral consultation in patients with low back pain who were referred to a spine specialty surgical clinic. METHODS: This was an observational study of patients presenting with low back pain with or without leg pain. The virtual interview was conducted by an experienced Advanced Practice Physiotherapist (APP) via telephone. The clinician documented the current symptoms, reviewed referral information including diagnostic imaging and made decisions regarding surgical appropriateness. Patients with cauda equina syndrome, metastatic spinal cord compression lesions, infection and fractures were excluded. Descriptive analysis and general linear modeling were conducted. RESULTS: A consecutive sample of 100 patients, 50 females (average age = 58, SD: 16, range 20-87 years) participated in the virtual assessment. Of 100 participants, 41 (41%) were deemed appropriate to proceed for an in-person assessment, with 36% being considered as potential surgical candidates (33 patients were seen by a spine surgeon and 3 were referred to a hip surgeon for hip arthritis). Fifty-nine (59%) patients did not require an in-person visit to the clinic. The most prominent reason for subsequent surgical assessment was leg dominant pain (neurogenic claudication/radiculopathy) with concordant imaging findings (27, 75%). There was a statistically significant association between surgical candidacy and presence of leg symptoms secondary to disc herniation or claudication (p = 0.0002) with no association with the scores of the PROMs or isolated imaging (P > 0.05). CONCLUSION: A structured virtual telephone interview was an effective means of triaging patients with LBP with and without leg pain with a potential of reducing the number of unnecessary visits to a spine surgeon. Radicular pain to the lower extremity was the most common symptom among participants who were directed to the surgeon.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.042 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".