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Research

The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation

Mélissa Nadeau, M. Patricia Rosas-Arellano, Kevin R. Gurr, Stewart I. Bailey, David C. Taylor, Ruby Grewal, D. Kirk Lawlor and Chris S. Bailey
CAN J SURG December 01, 2013 56 (6) 372-377; DOI: https://doi.org/10.1503/cjs.016512
Mélissa Nadeau
*Division of Orthopaedics, Department of Surgery, The University of Western Ontario, London, Ont.
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M. Patricia Rosas-Arellano
*Division of Orthopaedics, Department of Surgery, The University of Western Ontario, London, Ont.
†London Spine Centre, London Health Sciences Centre, London, Ont.
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Kevin R. Gurr
*Division of Orthopaedics, Department of Surgery, The University of Western Ontario, London, Ont.
†London Spine Centre, London Health Sciences Centre, London, Ont.
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Stewart I. Bailey
*Division of Orthopaedics, Department of Surgery, The University of Western Ontario, London, Ont.
†London Spine Centre, London Health Sciences Centre, London, Ont.
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David C. Taylor
‡Department of Surgery, Division of Vascular Surgery, The University of Western Ontario, London, Ont.
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Ruby Grewal
*Division of Orthopaedics, Department of Surgery, The University of Western Ontario, London, Ont.
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D. Kirk Lawlor
‡Department of Surgery, Division of Vascular Surgery, The University of Western Ontario, London, Ont.
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Chris S. Bailey
*Division of Orthopaedics, Department of Surgery, The University of Western Ontario, London, Ont.
†London Spine Centre, London Health Sciences Centre, London, Ont.
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  • For correspondence: [email protected]
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Article Figures & Tables

Tables

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    Table 1

    Statistical calculations used for analysis27

    TermDefinitionFormula
    SensitivityLikelihood that the diagnostic test will indicate the presence of disease when the disease is actually presentT+ ÷ (T+ + F−)
    SpecificityLikelihood that the diagnostic disease will indicate the absence of disease when the disease is actually absentT− ÷ (T− + F+)
    Positive likelihood ratioIndicates how much more likely it is to get a positive test in a person with than without the disease Embedded Image
    Negative likelihood ratioIndicates how much more likely it is to get a negative test in a person without than with the disease Embedded Image
    • F+ = false positive; F− = false negative; T+ = true positive; T− = true negative.

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    Table 2

    Interpretation of likelihood ratio values for clinical application27

    Likelihood ratioInterpretation
    > 10Strong evidence to rule in the disease
    5–10Moderate evidence to rule in the disease
    2–5Weak evidence to rule in the disease
    0.5–2No significant change in the likelihood of the disease
    0.2–0.5Weak evidence to rule out the disease
    0.1–0.2Moderate evidence to rule out the disease
    < 0.1Strong evidence to rule out the disease
    • View popup
    Table 3

    Symptom attributes for neurogenic intermittent claudication

    Attribute*Measure (95% CI)
    SensitivitySpecificityPLRNLR
    Single symptom attributes
    Trigger
     Standing (1)0.97 (0.81–1.0)0.70 (0.47–0.86)3.2 (1.7–5.9)†0.04 (0.0067–0.34)†
     Walking (2)0.90 (0.72–0.97)0.04 (0.0023–0.24)0.94 (0.81–1.1)2.30 (0.12–43)
    Alleviator
     Sitting (3a)0.83 (0.65–0.94)0.78 (0.56–0.92)3.80 (1.7–8.5)†0.21 (0.083–0.44)†
    Posture
     Shopping cart sign (4)0.80 (0.61–0.92)0.52 (0.31–0.73)1.70 (1.1–2.7)†0.38 (0.17–0.85)†
     Walking uphill (7)0.23 (0.11–0.43)0.78 (0.55–0.92)1.07 (0.39–2.9)0.98 (0.79–1.2)
    Nature
     Numbness (8)0.75 (0.55–0.89)0.41 (0.21–0.63)1.30 (0.84–1.9)0.61 (0.28–1.3)
     Cramping (9)0.53 (0.35–0.71)0.35 (0.17–0.57)0.82 (0.52–1.3)1.30 (0.78–2.3)
     Burning pain (10)0.62 (0.42–0.79)0.52 (0.31–0.73)1.30 (0.78–2.2)0.73 (0.42–1.3)
     Weakness (11)0.43 (0.25–0.63)0.59 (0.37–0.79)1.00 (0.54–2.0)0.97 (0.66–1.4)
    Location
     Above the knees (5)0.80 (0.61–0.92)0.65 (0.43–0.83)2.30 (1.3–4.1)†0.31 (0.14–0.66)†
    Time for relief
     > 10 min0.30 (0.15–0.50)0.78 (0.56–0.92)1.40 (0.53–3.6)0.89 (0.69–1.1)
    Constellation of symptom attributes
    Triggered with standing (1), alleviated with sitting (3a)0.80 (0.61–0.92)0.87 (0.65–0.97)6.10 (2.1–18)†0.23 (0.11–0.48)†
    Triggered with standing (1), alleviated with sitting (3a), located above the knees (5)0.67 (0.47–0.82)0.91 (0.70–0.98)7.70 (2.0–30)†0.37 (0.22–0.61)†
    Triggered with standing (1), alleviated with sitting (3a), located above the knees (5), positive shopping cart sign (4)0.57 (0.38–0.74)0.96 (0.76–1.0)13.00 (1.9–91)†0.45 (0.30–0.68)†
    • CI = confidence interval; NLR = negative likelihood ratio; PLR = positive likelihood ratio.

    • ↵* Numbers in brackets represent the corresponding question number in the questionnaire (see the Appendix, available at cma.ca/cjs).

    • ↵† Numbers whose values represent clinical significance.

    • View popup
    Table 4

    Symptom attributes for vascular intermittent claudication

    Attribute*Measure (95% CI)
    SensitivitySpecificityPLRNLR
    Single symptom attribute
    Trigger
     Walking (2)0.96 (0.76–1.00)0.10 (0.03–0.28)1.10 (0.92–1.2)0.43 (0.04–5.3)
    Symptom onset
     Predictable (2a)0.87 (0.65–0.97)0.37 (0.21–0.56)1.37 (1.0–1.9)0.36 (0.11–1.1)
    Alleviator
     Standing (3)0.78 (0.56–0.92)0.90 (0.72–0.97)7.80 (2.6–23)†0.24 (0.11–0.53)†
    Nature
     Numbness (8)0.59 (0.37–0.79)0.25 (0.11–0.45)0.79 (0.52–12)1.60 (0.80–3.3)
     Cramping (9)0.65 (0.43–0.83)0.47 (0.29–0.65)1.20 (0.78–1.9)0.75 (0.40–1.9)
     Burning pain (10)0.47 (0.27–0.69)0.38 (0.21–0.58)0.77 (0.46–1.3)1.37 (0.83–2.3)
     Weakness (11)0.41 (0.21–0.63)0.57 (0.37–0.75)0.95 (0.49–1.8)1.00 (0.69–1.5)
    Location
     Calves (6)0.78 (0.56–0.92)0.73 (0.54–0.87)2.90 (1.6–5.5)†0.30 (0.13–0.66)†
    Time for relief
     1–2 min (11a)0.57 (0.35–0.76)0.57 (0.38–0.74)1.30 (0.76–2.2)0.77 (0.46–1.3)
    Constellation of symptom attributes
    Alleviated with Standing (3), located in the calves (6)0.65 (0.43–0.83)0.97 (0.81–1.0)20.00 (2.8–140)†0.36 (0.21–0.63)†
    • CI = confidence interval; NLR = negative likelihood ratio; PLR = positive likelihood ratio.

    • ↵* Numbers in brackets represent the corresponding question number in the questionnaire (see the Appendix, available at cma.ca/cjs).

    • ↵† Numbers whose value represent clinical significance.

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Canadian Journal of Surgery: 56 (6)
CAN J SURG
Vol. 56, Issue 6
1 Dec 2013
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The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation
Mélissa Nadeau, M. Patricia Rosas-Arellano, Kevin R. Gurr, Stewart I. Bailey, David C. Taylor, Ruby Grewal, D. Kirk Lawlor, Chris S. Bailey
CAN J SURG Dec 2013, 56 (6) 372-377; DOI: 10.1503/cjs.016512

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The reliability of differentiating neurogenic claudication from vascular claudication based on symptomatic presentation
Mélissa Nadeau, M. Patricia Rosas-Arellano, Kevin R. Gurr, Stewart I. Bailey, David C. Taylor, Ruby Grewal, D. Kirk Lawlor, Chris S. Bailey
CAN J SURG Dec 2013, 56 (6) 372-377; DOI: 10.1503/cjs.016512
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