Referral Diagnosis Versus Electroneurophysiological Findings- Three Years Experience from a Tertiary Hospital
Abstract
An increasing number of requests for electrodiagnostic (EDX) tests is noted. Unnecessary referrals burden electrodiagnostic laboratories, prolonging waiting time for patients needing this examination. There are only a few studies investigating the distribution and concordance of EMG requests. This study is aimed to evaluate the requests of EDX tests and the concordance of referral diagnosis with EDX diagnosis. Electromyography laboratory database of our clinic between January 2008- December 2010 was used in this study. Data on examinees, referral physicians and diagnoses, electrodiagnostic findings were recorded. Entirely 2843 EDX tests had been performed and 142 of them had been excluded from the study because of missing data. Totally 2701 tests were included into the study and 1095 (40.5%) of whom were men. Mean age of patients was 48.3 ±12.6 years. Most of the EMG requests were done by neurologists (75.3%) and neurosurgeons (13.0%). Very few of EMGs were requested by general practitioners (0.7%).Polyneuropathy (29.2%), carpal tunnel syndrome (27.2%) and radiculopathy (10.2%) were the most common referral diagnoses. EMG results of 37.9% patients were in normal range. The referral diagnosis was concordant with EMG diagnosis in 52.6% of patients. This is the first study that demonstrates the distribution and concordance of EMG requests in Turkey. Most of EMGs were requested by specialists in our study. Polyneuropathy, CTS and radiculopathy were the most frequent diagnoses. Even though around 80% of EMG\'s were requested from neurology and/or neurosurgery clinics, half of diagnoses were concordant with EDX diagnoses.
Keywords
Electrodiagnosis referral diagnosis electromyography concordance electroneurophysiologic diagnosis
References
- Chemali KR, Tsao B. Electrodiagnostic testing of nerves and muscles: When, why, and how to order. Clev Clin J Med 2005;72(1):37-48
- Anonymous. Guidelines in electrodiagnostic medicine. American Association of Electrodiagnostic Medicine. Muscle Nerve 1999;22 (Suppl 8.):S107-8
- Danner R. Referral diagnosis versus electroneurophysi- ological finding. Two years electroneuromyographic con- sultation in a rehabilitation clinic. Electromyogr Clin Neurophysiol 1990;30:153-7
- Mondelli M, Giacchi M, Federico A. Requests for electromy- ography from general practitioners and specialists:critical evaluation. Ital J Neurol Sci 1998;19:195-203
- Podnar S. Critical reappraisal of referrals to electro- myography and nerve conduction studies. Eur J Neurol 2005;12:150-5.
- Cocito D, Tavella A, Ciaramitaro P, et al. A further criti- cal evaluation of requests for electrodiagnostic examina- tions. Neurol Sci 2006;26:419-22.
- Vodusek DB, Janko M. Electromyographic diagnostics- its possibilities and limitations. Zdrav Vestn 1983;53:189-92.
- Johnsen B, Fuglsang- Frederiksen A, Vingtoft S, et al. Differences in the handling of the EMG examination at seven European laboratories. Electroencephalogr Clin Neurophysiol 1994;93:155-8.
- Assmus H, Antoniadis G, Bischoff C, et al. Cubital tunnel syndrome-a review and management guidelines. Cent Eur Neurosurg 2011;72(2):90-8
Referral Diagnosis Versus Electroneurophysiological Findings- Three Years Experience from a Tertiary Hospital
Abstract
Elektrodiagnostik testler artan sayıda istenmektedir. Gerekli olmayan istemler elektrodiagnostik laboratuvarlarında yoğunluğa neden olmakta, hastaların uzun sure beklemesine yol açmaktadır. EMG istemleri ve dağılımlarını araştıran sınırlı sayıda çalışma bulunmaktadır. Bu çalışmada EDX test istemleri ve klinik öntanıların EDX tanıları ile uyumlarının araştırılması amaçlanmıştır. Bu çalışmada Elektromiyografi laboratuvarının Ocak 2008- Aralık 2010 arasındaki veritabanı kullanıldı. Fizik muayene, sevk eden hekimler ve ön tanıları ile elektrodiagnostik bulgular kaydedildi. Toplam 2843 test değerlendirildi, eksik verisi olan 142 hasta çalışma dışı bırakıldı. Çalışmaya 2701 test sonucu dahil edildi. Hastaların 1095’i (%40.5) erkek ve ortalama yaşları 48.3±12.6 yıldı. EMG istemlerini çoğu nörologlar (%75.3) ve beyin cerrahları (%13.0) tarafından yapılmıştı. Çok az kısmı (%0.7) pratisyenlerce istenmişti. Polinöropati (%29.2), Karpal tünel sendromu (%27.2) ve radikülopati (%10.2) en sık ön tanılardı. Yüzde 37.9 EMG normal sınırlarda bulundu. Hastaların %52.6’sında klinik ön tanı EDX tanısı ile uyumlu bulundu. Bu çalışma EMG istem dağılımlarını ve konkordansını gösteren Türkiye’deki ilk çalışmadır. EMG’lerin çoğun uzman doktorlarca istenmiştir. Polinöropati, KTS ve radikülopati en sık ön tanılardır. Yüzde 80 istemin nörolog ve beyin cerrahlarınca yapılmasına rağmen ön tanıların yarısı EDX tanısı ile uyumludur
References
- Chemali KR, Tsao B. Electrodiagnostic testing of nerves and muscles: When, why, and how to order. Clev Clin J Med 2005;72(1):37-48
- Anonymous. Guidelines in electrodiagnostic medicine. American Association of Electrodiagnostic Medicine. Muscle Nerve 1999;22 (Suppl 8.):S107-8
- Danner R. Referral diagnosis versus electroneurophysi- ological finding. Two years electroneuromyographic con- sultation in a rehabilitation clinic. Electromyogr Clin Neurophysiol 1990;30:153-7
- Mondelli M, Giacchi M, Federico A. Requests for electromy- ography from general practitioners and specialists:critical evaluation. Ital J Neurol Sci 1998;19:195-203
- Podnar S. Critical reappraisal of referrals to electro- myography and nerve conduction studies. Eur J Neurol 2005;12:150-5.
- Cocito D, Tavella A, Ciaramitaro P, et al. A further criti- cal evaluation of requests for electrodiagnostic examina- tions. Neurol Sci 2006;26:419-22.
- Vodusek DB, Janko M. Electromyographic diagnostics- its possibilities and limitations. Zdrav Vestn 1983;53:189-92.
- Johnsen B, Fuglsang- Frederiksen A, Vingtoft S, et al. Differences in the handling of the EMG examination at seven European laboratories. Electroencephalogr Clin Neurophysiol 1994;93:155-8.
- Assmus H, Antoniadis G, Bischoff C, et al. Cubital tunnel syndrome-a review and management guidelines. Cent Eur Neurosurg 2011;72(2):90-8
Details
| Primary Language | English |
|---|---|
| Journal Section | Original Articles |
| Authors | |
| Publication Date | December 1, 2014 |
| Published in Issue | Year 2014 |