Spine Specialists May Not Recognize Patients' Distress

Sensitivity for identifying patients with high levels of distress is below 30 percent

THURSDAY, Jan. 13 (HealthDay News) -- Spinal surgeons relying on their clinical impression often do not accurately identify patients in psychological distress, according to a study published in the Dec. 15 issue of the Journal of Bone & Joint Surgery.

Michael D. Daubs, M.D., of the University of Utah in Salt Lake City, and colleagues studied eight spinal specialists to determine the accuracy of their clinical impressions of patients' psychological distress level compared with results determined by a patient-completed questionnaire. The physicians evaluated 400 patients who also completed the Distress and Risk Assessment Method (DRAM) questionnaire. The physicians were blinded to the results of the questionnaire.

The researchers found that 64 percent of the patients had some level of psychological distress and 22 percent had high levels of distress. The physicians' sensitivity for identifying patients with high levels of distress was 28.7 percent with a positive predictive value of 47.2 percent. Sensitivity rates between more and less experienced surgeons were not significantly different. However, nonoperative spine specialists had a significantly higher sensitivity rate than did surgeons (41.7 versus 19.6 percent).

"Surgeons should consider the routine use of a validated questionnaire, such as the DRAM, to screen for psychological distress, and they should integrate the findings into their medical decision-making process," the authors write.

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