Development and internal validation of a field-based triage tool for lumbopelvic-hip dysfunction in collegiate athletes.

Abstract

Because lumbopelvic-hip (LPH) dysfunction in athletes is commonly associated with subsequent low back pain (LBP), this cross-sectional derivation and internal validation study aimed to develop and internally validate a clinical triage scoring system (CTSS) for field-based identification of collegiate athletes requiring priority intervention-namely, those who, in the judgment of experts, are likely to warrant further assessment and management. A total of 864 collegiate athletes (mean age 21.3 ± 2.4 years; 80.8% male) were recruited from 10 universities. Participants underwent standardized assessments including demographic characteristics, clinical history, and LPH functional testing. Using an expert-adjudicated binary reference standard (priority intervention vs self-management), a multivariable logistic regression model was developed to derive the weighted CTSS. Model performance was evaluated using discrimination, calibration, and decision curve analysis (DCA), and internal validation was performed using 1,000 bootstrap resamples. Of the 864 participants, 463 athletes (53.6%) were classified as requiring priority clinical assessment. The final 14-factor CTSS comprised 12 positive-weight predictors, such as localized LPH pain, muscle weakness, and higher body mass index, and 2 negative-weight predictors, positive Lasegue's sign and hamstring weakness, which functioned as safety-related modifiers. The model demonstrated acceptable discrimination (AUROC = 0.851, 95% CI: 0.824-0.876), with minimal optimism (optimism-corrected AUROC = 0.842) and excellent calibration (calibration slope = 0.996; calibration intercept = 0.0003). A total score of ≥9 was identified as the optimal threshold, yielding a sensitivity of 84.4% and specificity of 71.8%. DCA showed greater net benefit than treat-all and treat-none strategies across clinically relevant threshold probabilities (20%-50%), with a net benefit of 0.319 at a 50% threshold probability. The CTSS may provide a pragmatic field-based triage tool to support early identification of athletes who may benefit from priority intervention, although external validation is needed before broader implementation in sports medicine settings.