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[Analysis of patients referred to a specialist for spinal problems, in a population of adolescents].

OBJECTIVES
The aim of the study was to investigate the appropriateness of the referrals by family doctors to a specialist consultation for spine problems during growing age.


METHODS
Over the period 2001-2002 the Centro Riabilitazione Infantile (Child Rehabilitation Unit) performed 591 first physiatric consultations for boys and girls ageing 6 to 19 years, sent by 190 different family doctors. The diagnosis were classified in five different categories (scoliosis, hyper-kyphosis, back pain, small problem, no problems) and the results were grouped, according to definite threshold values, into false positive (cases not to be addressed to the specialist) and true positive (appropriate referral to the specialist). The data were processed through univariate analysis and non-parametric association tests.


RESULTS
The non appropriate referrals amounted to 62%, with no variations as far as the referring practitioner and the living place were concerned, but the percentage resulted higher in younger boys and in the case of scoliosis (62,3%); much smaller in kyphosis (25,2%). Scoliosis was diagnosed more frequently in females (as expected), kyphosis in males (not expected).


CONCLUSION
These data confirm the need of definite criteria and standards for the referral to a specialist for spine problems and moreover the convenience of measurement instruments. This would permit a more objective evaluation and the respect of threshold values for the referral to a specialist, in order to reduce the cases that do not need any treatment and for a more punctual referral of potentially curable problems.