The utility of patient symptom questionnaires in CT of the lumbosacral spine.

BACKGROUND: Lower back pain and radiculopathy impose significant burdens on healthcare systems. Computed tomography (CT) scans are often used as an imaging modality for lower back symptomatology in the community. Accurately identifying relevant symptom sources using CT scans is often challenging due to the high incidence of incidental structural abnormalities. We examine the effectiveness of patient questionnaires in assisting reporting of CT scans of the lumbosacral spine.

METHODS: In this retrospective audit, a questionnaire was provided to 250 consecutive patients undergoing lumbar spine CT prior to their scan being reported. Questions addressed the type of symptoms, such as pain and/or altered sensation, the location of these, and previous investigations. These questionnaires were provided with the lumbar spine CT scans, which were then reported by a pool of 30 radiologists.

RESULTS: Of the 250 questionnaires administered, one was excluded from analysis as peer-review feedback identified inconsistency with the inclusion criteria. Of the 249, 214 questionnaires were completed and included for further analysis. Of the 214 patients who completed the questionnaire, 211 of them had back pain (98.6%) whilst 3 (1.4%) did not. One hundred sixty-four (76.6%) patients had lumbar spine-related sensory symptoms (altered sensation or limb pain) whilst 50 (23.4%) did not. Of the 214 patients with completed questionnaires, 184 radiological reports referenced the questionnaires (86%), whereas 30 (14%) did not. Of the 214 patients, 33 (15.4%) had clinical request information that suggested alternate pathology to what was indicated on the questionnaire. In these 33 cases, 28 (84.8%) radiological reports made direct reference to the patient questionnaire. For the 164 patients with lumbar spine-related sensory symptoms, 24 (14.6%) had incongruent clinical request information with questionnaires. In these 24 cases, 19 (79.2%) had radiological reports which made reference to the questionnaire. For the 50 patients with lower back pain as their sole symptom, 9 (18%) had incongruent clinical request information with questionnaires. In all 9 (100%) of these cases, radiological reports referenced the questionnaires. The questionnaire identified that 199 out of 214 patients (93%) had external lower back imaging available.

CONCLUSIONS: Inclusion of a symptom questionnaire has benefit to the reporting radiologist. We observed a high completion and usage rate of the questionnaire, which may indicate feasible use in regular workflows. Importantly, we noted that patient questionnaires help with providing accurate clinical information and are especially important for cases in which there are differing accounts of patient symptomatology, both for patients with lumbar spine-related sensory symptoms and for those with lower back pain as a sole symptom. Furthermore, they can inform radiologists when external lower back imaging is available. These factors can assist the radiologist in providing higher quality reports, ideally resulting in better patient outcomes.