Kritična analiza napotitev na elektrodiagnostično preiskavo perifernega živčevja
Podnar, Simon
Background. Clinical neurophysiologists observe a large number of examinees referred to the electromyographic (EMG) laboratory without clinical symptoms or signs of the peripheral nervozzs system ...lesion. Such referrals do not improve management of patients, but only unnecessarily burden examinees and laboratory personnel. The aim of the present study was to check appropriateness of referrals to electrodiagnostic examination, look for reasons for problems and suggest possible improvements. Methods. From the database of the Institute of Clinical Neurophysiology in Ljubljana all examinees evaluated by the author in a "general" EMG laboratory in the fir,st 4 months of 2002 were included. From data about examinees, referral doctors, referral diagnoses, clinical symptoms and signs and electrophysiological findings, predictive values for neurological referral diagnoses and electrodiagnostic abnormalities were calculated using descriptive and multivariate statistical analyses. Results. Three-hundred examinees, 42% men, were included. Neurological diagnosis was provided in 55% of referrals. Electrodiagnostic abnormalities were found in 45% of examinees (carpal tunnel syndrome 50%, radiculopathy 25%, other mononeuropathies 15%, polineuropathy 9%). In 9% of examinees only clinical, and in 48% neither clinical nor electrodiagnostic abnormalities were demonstrated. Using multivariate analysispositive effect of referral with neurological diagnosis, of paraesthesiae and findings of weakness and sensory loss, and negative effect of pain and referral diagnosis cervicobrachialgia or lumboihialgia on pathological electrodiagnostic findings were found. Isolated pain and paraesthesiae (with carpal tunnel syndrome excluded) were particularly poor predictors of abnormal electrodiagnostic findings (9% and 16%, respectively). (Abstract truncated at 2000 characters)
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