Intermountain Medical Group, Salt Lake City, UT, USA.
J Am Board Fam Med. 2010 Sep-Oct;23(5):584-90. doi: 10.3122/jabfm.2010.05.100071.
Focal and generalized neuropathies, such as carpal tunnel syndrome and diabetic peripheral neuropathy, have high prevalence among the US population. Primary care physicians are increasingly using computerized electrodiagnostic (EDX) testing to evaluate these patients. The impact of this diagnostic modality on physician diagnostic reasoning and patient management has not been directly studied.
Consecutive computerized EDX tests conducted in a primary care clinic were prospectively evaluated using a diagnostic before-and-after study design. The pretest diagnosis and patient management plan were noted before EDX testing. Five clinical outcomes were assessed after the test: (1) test abnormality, (2) confirmation of pretest diagnosis, (3) change in pretest diagnosis, (4) expansion of pretest diagnosis, and (5) change to patient management plan.
One hundred computerized EDX tests were performed among 85 patients. A total of 88 tests were abnormal. The pretest diagnosis was confirmed in 59 tests. The pretest diagnosis was changed by 14 tests and it was expanded by 18 tests. The computerized EDX tests triggered a change in clinical management in 30 cases, with referral to orthopedic surgery and metabolic workup for polyneuropathy as the most common changes.
Computerized EDX testing was clinically valuable in patients with moderate to high pretest probability of common neuropathies such as carpal tunnel syndrome and diabetic polyneuropathy. In approximately one third of cases, the test led to a change in clinical management.
局限性和全身性神经病变，如腕管综合征和糖尿病周围神经病变，在美国人群中患病率较高。初级保健医生越来越多地使用计算机化的电诊断（EDX）检测来评估这些患者。这种诊断方式对医生诊断推理和患者管理的影响尚未直接研究。
使用诊断前后研究设计，对在初级保健诊所进行的连续计算机化 EDX 检测进行前瞻性评估。在 EDX 检测之前记录了测试前的诊断和患者管理计划。在测试后评估了 5 个临床结果：（1）测试异常，（2）确认测试前的诊断，（3）改变测试前的诊断，（4）扩展测试前的诊断，以及（5）改变患者管理计划。
在 85 名患者中进行了 100 次计算机化 EDX 检测。共有 88 次测试异常。59 次测试前的诊断得到了确认。14 次测试前的诊断发生了改变，18 次测试前的诊断得到了扩展。计算机化 EDX 测试促使 30 例临床管理发生变化，最常见的变化是转诊到矫形外科和代谢性神经病检查。
在中度至高度测试前患有常见神经病变（如腕管综合征和糖尿病多发性神经病）的患者中，计算机化 EDX 检测具有临床价值。大约三分之一的病例，测试导致了临床管理的改变。
