Objective: Patient-Reported Outcome Measures (PROMs) have become integral to assess treatment efficacy in spine surgery; however, their use as triage tools to predict surgical eligibility in outpatient settings remains limited. This study evaluates the feasibility of incorporating standardized PROMs into the outpatient workflow to predict the likelihood of surgery in patients presenting with lumbar spine pathologies. Methods: A total of 204 patients referred for their first neurosurgical consultation for low back pain, with or without radicular symptoms, were prospectively enrolled. After exclusions, 172 patients were analyzed. Standardized PROMs – including the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), Core Outcome Measures Index (COMI), and European Quality of life - 5 Dimensions - 5 Levels (EQ-5D-5L) - were collected electronically. Patient flow was monitored regarding surgical decision, conservative treatment, or referral to other specialties. Random forest models were tested using each Patient-Reported Outcomes Measure (PROM) score, the combination of total scores, and models based on the top five and eight features. Results: After the first consultation, only 18% of patients were treated with surgery, with an additional 9% requiring surgery after failure of conservative management. Of the tested PROMs, the ODI demonstrated the highest accuracy as well as the best balance of positive and negative predictive value for identifying surgical candidates. PROMs combination models did not improve overall accuracy or predictive balance. Conclusion: A revision of traditional referral processes for spine pathology patients may be warranted to identify surgical candidates, optimize patient triage, patient flow and resource allocation. Due to its brevity and predictive performance, the ODI may serve as a rough triage tool for identifying potential surgical candidates in outpatient lumbar spine clinics.
Mahler et al. (Mon,) studied this question.