TY  - JOUR
PY  - 2019//
TI  - Validation of the Shin Pain Scoring System: a novel approach for determining tibial bone stress injuries
JO  - Orthopaedic journal of sports medicine
A1  - Nussbaum, Eric D.
A1  - Gatt, Charles J.
A1  - Epstein, Robert
A1  - Bechler, Jeffrey R.
A1  - Swan, Kenneth G.
A1  - Tyler, David
A1  - Bjornaraa, Jaynie
SP  - e2325967119877803
EP  - e2325967119877803
VL  - 7
IS  - 10
N2  - BACKGROUND: The incidence of adolescent overuse injuries, including bone stress injuries (BSIs), is on the rise. The identification of a BSI in the early stages is key to successful treatment. The Shin Pain Scoring System (SPSS) was developed to aid clinicians in identifying patients with a BSI. HYPOTHESIS: The SPSS will correlate with magnetic resonance imaging (MRI) grading of a BSI in an adolescent population. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. <br><br>METHODS: Enrolled in this study were 80 adolescent high school athletes between the ages of 13 and 18 years participating in a variety of sports with more than 1 week of atraumatic shin pain. The SPSS questionnaire was completed for each participant, and physical examination findings were recorded. Each question and physical examination item was allotted a point value, which totaled 29 points. Radiographs and MRI scans of both lower legs were obtained for each participant. The SPSS score was statistically analyzed using logistic regression, a classification matrix, and a 2 × 2 contingency table to evaluate validity and predictability. <br><br>RESULTS: Logistic regression analysis of our data determined that 3 categories of SPSS scores provided the highest diagnostic value when compared with MRI grading based on the Fredericson classification (0-4). The SPSS correctly identified 43.5% of injuries for category 1 (MRI grades 0-1), 62.5% for category 2 (MRI grade 2), and 50.0% for category 3 (MRI grades 3-4). Overall, the SPSS correctly identified the degree of BSI in 54.4% of all tibias studied. Binary analysis for validity demonstrated a sensitivity of 96%, specificity of 26%, positive predictive value of 76%, and negative predictive value of 71% for the SPSS relative to the "gold standard" MRI results. <br><br>CONCLUSION: The SPSS is a potentially valid method to identify tibial BSIs, given the sensitivity and negative and positive predictive values. It also provides helpful categorization to alert clinicians to the presence of a BSI and direct further diagnostics and/or interventions. The SPSS should be considered as an additional tool to use when evaluating adolescents with atraumatic tibial BSIs.<br><br>© The Author(s) 2019.<p />  <p>Language: en</p>
LA  - en
SN  - 2325-9671
UR  - http://dx.doi.org/10.1177/2325967119877803
ID  - ref1
ER  -