Triage Tool for Early Referral to Spinal Cord Stimulation in Chronic Pain Patients
Author Information
Author(s): Bastiaens Ferdinand, van Hooff Miranda L., Bruaset Ivar J., van den Eede Els, Maandag Natasja J. G., Kurt Erkan, Schel‐Huisman Monique C. M., Wegener Jessica T., Vissers Kris C. P.
Primary Institution: Sint Maartenskliniek Nijmegen, The Netherlands
Hypothesis
Can a triage tool effectively identify patients with chronic back and leg pain who are eligible for spinal cord stimulation consultation?
Conclusion
The triage tool is feasible, reliable, and accurate, potentially improving patient selection and reducing waiting times for spinal cord stimulation.
Supporting Evidence
- The triage tool was evaluated as feasible with a mean System Usability Score of 74.2.
- Inter-rater reliability was classified as good with a Fleiss' Kappa of 0.79.
- Sensitivity of the triage tool was 100% and specificity was 98.8%.
- The positive predictive value was 40% and the negative predictive value was 100%.
- The tool was developed based on Dutch SCS guidelines and expert panel consultation.
- Implementation involved a multidisciplinary team and continuous improvement cycles.
- 1025 patients were assessed, with 20 identified for fast-track consultation.
- Future research is needed to optimize the tool's performance.
Takeaway
Doctors created a tool to help find patients who need special treatment for back and leg pain faster, which could help them feel better sooner.
Methodology
A mixed methods design was used to develop, implement, and evaluate the triage tool based on Dutch guidelines and expert consultations.
Potential Biases
Potential confounding by indication where patients indicated for SCS may benefit more from other treatments.
Limitations
The low number of positive triage indications may skew predictive accuracy, and the study's monocentric design limits generalizability.
Participant Demographics
Patients on the orthopaedic waiting list with chronic low back and leg pain, regardless of previous spinal surgery.
Statistical Information
Confidence Interval
95%CI 87.5–1 for sensitivity, 95%CI 97.7–99.5 for specificity
Digital Object Identifier (DOI)
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