Abstract
The aims are to evaluate electrodiagnostic testing (EDX) requests and verify if presence, consistency and agreement of referral diagnosis could be predicted by patient demographic findings and referring physician typology, and if there were differences in respect to our previous study performed 16 years ago. The study concerns EDX requests referred to two electromyography labs during the year 2011. Differences between findings of general practitioners (GPs) versus specialists’ requests and between this study with the previous were assessed. Multivariate logistic regression was performed to calculate odds ratio to assess the strength of association between presence, consistency and agreement of referral diagnosis with patient demographic findings and referring physician typology. We evaluated EDX requests of 1,586 patients (mean age 56 ± 16.7 years, 58.8 % women), 1,050 (66.2 %) were referred by GPs and 536 (33.8 %) by specialists. The suspected diagnosis was reported in 1,033 (65.1 %) requests, the overall consistency was 79.9 % and agreement was 71.9 %. Presence, consistency and agreement of referral diagnosis were predicted by physician’s typology (specialist). Only if the suspected diagnosis was carpal tunnel syndrome, consistency and agreement were high regardless of doctor’s typology. The physicians, especially GPs, who reported the referral diagnosis decreased during the past 16 years. A diagnostic test, including EDX, should be considered mainly if it fits into the best diagnostic strategy. The neurophysiologist should decide if EDX is useful, make the best decision on further management, and not submit patients to unnecessary and uncomfortable procedures. This choice of behaviour could be questionable and may lead to ethical and deontological problems.
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Fuller G (2005) How to get the most out of nerve conduction studies and electromyography. J Neurol Neurosurg Psychiatry 76(Supll. II):ii41–ii46
Mondelli M, Giacchi M, Federico A (1998) Requests for electromyography from general practitioners and specialists: critical evaluation. Ital J Neurol Sci 19:195–203
Danner R (1990) Referral diagnosis versus electroneurophysiological finding. Two years electroneuromyographic consultation in a rehabilitation clinic. Electromyogr Clin Neurophysiol 30:153–157
Kothari MJ, Preston DC, Plotkin GM et al (1995) Electromyography: do the diagnostic ends justify the means? Arch Phys Med Rehabil 76:947–949
Haig AJ, Tzeng HM, LeBreck DB (1999) The value of electrodiagnostic consultation for patients with upper extremity nerve complaints: a prospective comparison with the history and physical examination. Arch Phys Med Rehabil 80:1273–1281
Kothari MJ, Blakeslee MA, Reichwein R et al (1998) Electrodiagnostic studies: are they useful in clinical practice? Arch Phys Med Rehabil 79:1510–1511
Nardin RA, Rutkove SB, Raynor EM (2002) Diagnostic accuracy of electrodiagnostic testing in the evaluation of weakness. Muscle Nerve 26:201–205
Cho SC, Siao-Tick-Chong P, So YT (2004) Clinical utility of electrodiagnostic consultation in suspected polyneuropathy. Muscle Nerve 30:659–662
Podnar S (2005) Critical reappraisal of referrals to electromyography and nerve conduction studies. Eur J Neurol 12:150–155
Cocito D, Tavella A, Ciaramitaro P et al (2006) A further critical evaluation of requests for electrodiagnostic examinations. Neurol Sci 26:419–422
Perry DI, Tarulli AW, Nardin RA et al (2009) Clinical utility of electrodiagnostic studies in the inpatient setting. Muscle Nerve 40:195–199
Mondelli M, Rossi S, Ballerini M, Mattioli S (2013) Factors influencing the diagnostic process of carpal tunnel syndrome. Neurol Sci 34:1197–1205
Claes F, Bernsen H, Meulstee J, Verhagen WI (2012) Carpal tunnel syndrome diagnosed by general practitioners: an observational study. Neurol Sci 33:1079–1081
Fuglsang-Frederiksen A, Johnsen B et al (1995) Variation in performance of the EMG examination at six European laboratories. Electroencephalogr Clin Neurophysiol 97:444–450
Fuglsang-Frederiksen A, Pugdahl K (2011) Current status on electrodiagnostic standards and guidelines in neuromuscular disorders. Clin Neurophysiol 122:440–455
Cocito D (2011) New Year’s resolutions versus real life. Clin Neurophysiol 122:428–429
Rigler I, Podnar S (2007) Impact of electromyographic findings on choice of treatment and outcome. Eur J Neurol 14:783–787
Johnsen B, Fuglsang-Frederiksen A et al (1994) Differences in the handling of the EMG examination at seven European laboratories. Electroencephalogr Clin Neurophysiol 93:155–158
Johnsen B, Fuglsang-Frederiksen A et al (1995) Inter- and intraobserver variation in the interpretation of electromyographic tests. Electroencephalogr Clin Neurophysiol 97:432–443
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We are very grateful to our Italian-Canadian friend Prof. Romano Bragaglia of Bologna University for the revision of the manuscript.
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The authors state that there are no conflicts of interest and that they have not received any financial support.
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Mondelli, M., Aretini, A. & Greco, G. Requests of electrodiagnostic testing: consistency and agreement of referral diagnosis. What is changed in a primary outpatient EMG lab 16 years later?. Neurol Sci 35, 669–675 (2014). https://doi.org/10.1007/s10072-013-1574-7
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DOI: https://doi.org/10.1007/s10072-013-1574-7