Abstract
Objective
To determine the accuracy of clinical features in diagnosing vertebral fracture in
low back pain patients and assess the psychometric properties of the Quality Assessment
of Studies of Diagnostic Accuracy Included in Systematic Reviews (QUADAS) scale.
Study Design and Setting
A diagnostic systematic review was performed on all available records in MEDLINE,
CINAHL, and EMBASE. Studies were considered eligible if they investigated clinical
features associated with vertebral fracture in a cohort of low back pain patients.
All eligible studies were assessed for methodological quality using the QUADAS scale,
and two authors extracted true-positive, true-negative, false-positive, and false-negative
data for each clinical feature.
Results
Twelve studies were identified by the review, investigating 51 clinical features.
Five clinical features were useful to raise or lower the probability of vertebral
fracture: age >50 years (likelihood ratio [LR]+=2.2, LR−=0.34), female gender (LR+=2.3, LR−=0.67), major trauma (LR+=12.8, LR−=0.37), pain and tenderness (LR+=6.7, LR−=0.44), and a distracting painful injury (LR+=1.7, LR−=0.78). The QUADAS had low internal consistency, and only three items had high inter-rater
reliability. There was inadequate reporting of many methodological quality items.
Conclusion
Five clinical features were identified that can be used to screen for vertebral fracture.
The psychometric properties of the QUADAS scale raise concerns about its use to rate
the quality of low back pain diagnosis studies.
Keywords
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Article info
Publication history
Published online: August 28, 2007
Accepted:
April 20,
2007
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
