Taylor Therriault1, Alexander Rospert1, Mitchell Selhorst2, Anastasia Fischer3. 1. Sports and Orthopedic Physical Therapy, Nationwide Children's Hospital, Columbus, OH, United States. 2. Sports and Orthopedic Physical Therapy, Nationwide Children's Hospital, Columbus, OH, United States. Electronic address: mitchell.selhorst@nationwidechildrens.org. 3. Division of Sports Medicine, Nationwide Children's Hospital, Columbus, OH, United States.
Abstract
AIMS: The primary aim of this study was to develop a diagnostic cluster of common clinical findings that would assist in ruling out an active spondylolysis in adolescent athletes with low back pain (LBP). DESIGN: Retrospective case-series. SETTING: Hospital-based sports medicine clinic. PATIENTS: One thousand and twenty-five adolescent athletes with LBP (age 15.0 ± 1.8 years, 56% female) were reviewed. Active spondylolytic injuries were identified in 22% (n = 228) of these patients. MAIN OUTCOME MEASURE: presence or absence of active spondylolysis on advanced imaging. RESULTS: Through logistic regression analysis, pain with extension (p < 0.001), difference between active and resting pain ≥3/10 (p < 0.001), and male sex (p = 0.002) were identified as significantly associated with active spondylolysis. The clinical cluster had a sensitivity of 88% (95% CI 83%-93%) to help rule out active spondylolysis. The negative likelihood ratio was 0.34 (95% CI 0.23-0.51) and the negative predictive value was 90% (95% CI 86%-93%). Diagnostic accuracy of the cluster was acceptable (area under the curve = 0.72 (95% CI 0.69, 0.76; p < 0.001). CONCLUSION: This study found a cluster of three patient characteristics that may assist in ruling out active spondylolysis in adolescent athletes with LBP.
AIMS: The primary aim of this study was to develop a diagnostic cluster of common clinical findings that would assist in ruling out an active spondylolysis in adolescent athletes with low back pain (LBP). DESIGN: Retrospective case-series. SETTING: Hospital-based sports medicine clinic. PATIENTS: One thousand and twenty-five adolescent athletes with LBP (age 15.0 ± 1.8 years, 56% female) were reviewed. Active spondylolytic injuries were identified in 22% (n = 228) of these patients. MAIN OUTCOME MEASURE: presence or absence of active spondylolysis on advanced imaging. RESULTS: Through logistic regression analysis, pain with extension (p < 0.001), difference between active and resting pain ≥3/10 (p < 0.001), and male sex (p = 0.002) were identified as significantly associated with active spondylolysis. The clinical cluster had a sensitivity of 88% (95% CI 83%-93%) to help rule out active spondylolysis. The negative likelihood ratio was 0.34 (95% CI 0.23-0.51) and the negative predictive value was 90% (95% CI 86%-93%). Diagnostic accuracy of the cluster was acceptable (area under the curve = 0.72 (95% CI 0.69, 0.76; p < 0.001). CONCLUSION: This study found a cluster of three patient characteristics that may assist in ruling out active spondylolysis in adolescent athletes with LBP.