目的:从头脊柱感染是一个日益严重的医学问题。从头脊柱感染的手术或非手术治疗的决策通常是非基于证据的过程,通常是由单个医师逐案决定。与其他纯粹基于放射学的评分系统或单个高级医师的判断相比,基于最新证据的评分系统可能有助于改善决策过程。
方法:确定了在2019年至2021年间接受非手术或手术治疗的18岁以上脊柱感染患者。神经状态的临床数据,疼痛,现有的合并症被收集并转移到匿名电子表格中。没有MR图像和受影响脊柱区域CT扫描的患者被排除在研究之外。一个多学科专家小组使用了脊柱不稳定性肿瘤评分(SINS),脊髓不稳定脊椎盘炎评分(SISS),和脊柱感染治疗评估评分(SITE评分),以前由作者小组开发,每个临床病例。专家小组的每位医生都为每位患者提供了手术或非手术治疗的个人治疗建议。治疗建议形成了专家小组的意见,用于计算每个评分的预测效价。
结果:共发现263例脊柱感染患者。在排除了加倍的病人后,没有新生感染的患者,或者没有CT和MRI扫描的人,123名患者仍在接受调查。总的来说,70.70%的患者接受手术治疗,29.30%的患者接受非手术治疗。现场分数的类内相关系数(ICC),罪过,和SISS为0.94(95%CI0.91-0.95,p<0.01),0.65(95%CI0.91-0.83,p<0.01),和0.80(95%CI0.91-0.89,p<0.01)。与专家小组的决定相比,所有纳入患者的SITE评分敏感性为96.97%,特异性为81.90%.对于潜在的不稳定和不稳定的病变,SISS和SINS的灵敏度分别为84.42%和64.07%,分别,以及31.16%和56.52%的特异性,分别。与SINS和SISS的潜在不稳定和不稳定病变相比,SITE评分显示出更高的总体敏感性,为97.53%,对硬膜外脓肿患者的特异性更高(75.00%)。现场评分显示,与专家小组决定有关的最终治疗决定的一致性明显较高,与一位医生对脊椎盘炎患者的决定相比,门徒,或者脊髓骨髓炎.
结论:关于多学科专家小组的治疗建议,SITE评分显示出高敏感性和特异性。与基于放射学的评分系统或单个医生相比,SITE评分显示出更高的预测有效性,并且对硬膜外脓肿患者具有很高的有效性。
OBJECTIVE: De novo spinal infections are an increasing medical problem. The decision-making for surgical or nonsurgical treatment for de novo spinal infections is often a non-evidence-based process and commonly a case-by-case decision by single physicians. A scoring system based on the latest evidence might help improve the decision-making process compared with other purely radiology-based scoring systems or the judgment of a single senior physician.
METHODS: Patients older than 18 years with an infection of the spine who underwent nonsurgical or surgical treatment between 2019 and 2021 were identified. Clinical data for neurological status, pain, and existing comorbidities were gathered and transferred to an anonymous spreadsheet. Patients without an MR image and a CT scan of the affected spine region were excluded from the investigation. A multidisciplinary expert panel used the Spine Instability Neoplastic Score (SINS), Spinal Instability Spondylodiscitis Score (SISS), and Spinal Infection Treatment Evaluation Score (SITE Score), previously developed by the authors\' group, on every clinical case. Each physician of the expert panel gave an individual treatment recommendation for surgical or nonsurgical treatment for each patient. Treatment recommendations formed the expert panel opinion, which was used to calculate predictive validities for each score.
RESULTS: A total of 263 patients with spinal infections were identified. After the exclusion of doubled patients, patients without de novo infections, or those without CT and MRI scans, 123 patients remained for the investigation. Overall, 70.70% of patients were treated surgically and 29.30% were treated nonoperatively. Intraclass correlation coefficients (ICCs) for the SITE Score, SINS, and SISS were 0.94 (95% CI 0.91-0.95, p < 0.01), 0.65 (95% CI 0.91-0.83, p < 0.01), and 0.80 (95% CI 0.91-0.89, p < 0.01). In comparison with the expert panel decision, the SITE Score reached a sensitivity of 96.97% and a specificity of 81.90% for all included patients. For potentially unstable and unstable lesions, the SISS and the SINS yielded sensitivities of 84.42% and 64.07%, respectively, and specificities of 31.16% and 56.52%, respectively. The SITE Score showed higher overall sensitivity with 97.53% and a higher specificity for patients with epidural abscesses (75.00%) compared with potentially unstable and unstable lesions for the SINS and the SISS. The SITE Score showed a significantly higher agreement for the definitive treatment decision regarding the expert panel decision, compared with the decision by a single physician for patients with spondylodiscitis, discitis, or spinal osteomyelitis.
CONCLUSIONS: The SITE Score shows high sensitivity and specificity regarding the treatment recommendation by a multidisciplinary expert panel. The SITE Score shows higher predictive validity compared with radiology-based scoring systems or a single physician and demonstrates a high validity for patients with epidural abscesses.