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Observer agreement in the choice of lumbar spine injection for pain management

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Abstract

Background and purpose

Lumbar spine MRI can help guide the choice of corticosteroid injection in pain management. We investigated whether patient-reported symptom information from a questionnaire could improve agreement in the choice of type, level, and side of injection.

Materials and methods

In this prospective observational study, 120 patients (median age 64, 70 men) were recruited from patients referred for pain management. After informed consent, they completed electronic questionnaires that obtained symptom information for later use during MRI reviews. In 3 research arms, 6 radiologists chose injections that would ideally deliver corticosteroid to the presumed sources of pain in (1) MRI studies reviewed with symptom information from questionnaires, (2) MRI studies reviewed without symptom information, and (3) MRI reports. Blinded to questionnaire results, radiologists providing clinical care and interviewing patients chose ideal therapeutic injections to establish reference standards. Injections were categorized by type, level, and side and compared using percent agreement and kappa statistics. Interreading agreement was analyzed.

Results

Compared to the reference standard, kappa agreements for injection types, levels, and sides were almost perfect when MRIs were reviewed knowing symptoms (0.85–0.93), fair without symptoms (0.23–0.35) (all P < .001) and fair in MRI reports (0.24–0.36) (all P < .001). Interreading kappa agreements were almost perfect knowing symptoms (0.82–0.90), but only moderate without symptoms (0.42–0.49) (all P < .001).

Conclusions

Radiologists reviewing lumbar spine MRI converged on the type, level, and side of ideal therapeutic injection whether they obtained symptom information from direct patient interview or electronic questionnaire. Observer agreement was significantly lower without symptom information.

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Acknowledgements

The authors thank Daniel Rosenthal for his impactful comments and recommendations.

Funding

Funding was available through a Departmental grant (Ralph Schlaeger Research Fellowship Grant).

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Authors and Affiliations

  1. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street YAW 6030, Boston, MA, 02114, USA

    Rene Balza, Sarah F. Mercaldo, Connie Y. Chang, Ambrose J. Huang, Jad S. Husseini, Arvin B. Kheterpal, F. Joseph Simeone & William E. Palmer

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  1. Rene Balza
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Correspondence to William E. Palmer.

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Balza, R., Mercaldo, S.F., Chang, C.Y. et al. Observer agreement in the choice of lumbar spine injection for pain management. Skeletal Radiol 50, 2495–2501 (2021). https://doi.org/10.1007/s00256-021-03819-3

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  • DOI: https://doi.org/10.1007/s00256-021-03819-3

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