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Table 3 Identification of patients for ‘fast-track’ referrals to spinal specialist services. Three scenarios investigated

From: Subgrouping patients with sciatica in primary care for matched care pathways: development of a subgrouping algorithm

  Sensitivity (95% CIa) Specificity (95% CI) Positive predictive value (95% CI) Negative predictive value (95% CI) % of total sample referred
Use of only clinical characteristics (total of 4b):
- Patients with 3 out of 4 clinical characteristics 68% (55–80) 60% (55–65) 21% (15–27) 93% (88–96) 43% (186/429)
- Patients with all 4 clinical characteristics 32% (20–45) 89% (85–92) 30% (19–44) 89% (86–92) 14% (59/429)
Use of clinical characteristics combined with STarT Back prognostic risk score (medium, high)c
- patients at ‘high’ risk on STarT Back, with 3 or more clinical characteristics 51% (37–64) 73% (68–78) 22% (16–31) 91% (87–94) 30% (129/429)
OR
- patients at ‘medium’ risk on STarT Back, with all 4 clinical characteristics      
  1. aCI; Confidence Intervals
  2. bCurrent leg pain > 6 (NRS 0–10), pain below knee, interference with ability to do work/home activities > 6 (NRS 0–10) or ‘yes’ response on the RMDQ item, sensory deficit in painful leg with pin/prick testing
  3. cPatients with a low risk STarT Back score were excluded from this analysis, as from the ATLAS cohort, only one patient at low risk of poor outcome was referred to spinal specialist services