Homan M M, Franzblau A, Werner R A, Albers J W, Armstrong T J, Bromberg M B
Department of Environmental and Industrial Health, University of Michigan School of Public Health, Ann Arbor 48109-2029, USA.
Scand J Work Environ Health. 1999 Apr;25(2):115-24. doi: 10.5271/sjweh.413.
The goal of this study was to evaluate the concordance between various clinical screening procedures for carpal tunnel syndrome.
The subject population consisted of 824 workers from 6 facilities. The evaluated procedures included bilateral sensory nerve conduction testing, physical examinations, and symptom surveys, including hand diagrams. The agreement between the outcomes of various combinations of these procedures was assessed by determining the kappa coefficient.
There was relatively poor overlap between the reported symptoms, the physical examination findings, and the electrodiagnostic results consistent with carpal tunnel syndrome. Overall, only 23 out of 449 subjects (5%) with at least 1 positive finding met all 3 criteria (symptoms, physical examination findings, and electrophysiological results consistent with carpal tunnel syndrome) for the dominant hand. The screening procedures showed poor or no agreement with kappa values ranging between 0.00 and 0.18 for all the case definitions evaluated for carpal tunnel syndrome.
The poor overlap between the various screening procedures warns against the use of electrodiagnostic findings alone without the symptom presentation being considered. The results of this study also point to a need for the further development and evaluation of methods for detecting carpal tunnel syndrome.
本研究的目的是评估腕管综合征各种临床筛查程序之间的一致性。
研究对象包括来自6个机构的824名工人。评估的程序包括双侧感觉神经传导测试、体格检查以及症状调查，包括手部绘图。通过确定kappa系数来评估这些程序的各种组合结果之间的一致性。
报告的症状、体格检查结果以及与腕管综合征一致的电诊断结果之间的重叠相对较差。总体而言，在449名至少有1项阳性结果的受试者中，只有23人（5%）的优势手符合所有3项标准（症状、体格检查结果以及与腕管综合征一致的电生理结果）。对于评估的所有腕管综合征病例定义，筛查程序显示出较差的一致性或无一致性，kappa值在0.00至0.18之间。
各种筛查程序之间较差的重叠警示不要仅根据电诊断结果而不考虑症状表现。本研究结果还表明需要进一步开发和评估检测腕管综合征的方法。
