Dyck Peter J, Overland Carol J, Low Phillip A, Litchy William J, Davies Jenny L, Dyck P James B, Carter Rickey E, Melton L Joseph, Andersen Henning, Albers James W, Bolton Charles F, England John D, Klein Christopher J, Llewelyn Gareth, Mauermann Michelle L, Russell James W, Selvarajah Dinesh, Singer Wolfgang, Smith A Gordon, Tesfaye Solomon, Vella Adrian
Arch Neurol. 2012 Dec;69(12):1609-14. doi: 10.1001/archneurol.2012.1481.
OBJECTIVE To repeat the Clinical vs Neurophysiology (Cl vs N Phys) trial using "unequivocally abnormal" signs and symptoms (Trial 2) compared with the earlier trial (Trial 1), which used "usual" signs and symptoms. DESIGN Standard and referenced nerve conduction abnormalities were used in both Trials 1 and 2 as the standard criterion indicative of diabetic sensorimotor polyneuropathy. Physician proficiency (accuracy among evaluators) was compared between Trials 1 and 2. SETTING Academic medical centers in Canada, Denmark, England, and the United States. PARTICIPANTS Thirteen expert neuromuscular physicians. One expert was replaced in Trial 2. RESULTS The marked overreporting, especially of signs, in Trial 1 was avoided in Trial 2. Reproducibility of diagnosis between days 1 and 2 was significantly (P = .005) better in Trial 2. The correlation of the following clinical scores with composite nerve conduction measures spanning the range of normality and abnormality was improved in Trial 2: pinprick sensation (P = .03), decreased reflexes (P = .06), touch-pressure sensation (P = .06), and the sum of symptoms (P = .06). CONCLUSIONS The simple pretrial decision to use unequivocally abnormal signs and symptoms-taking age, sex, and physical variables into account-in making clinical judgments for the diagnosis of diabetic sensorimotor polyneuropathy (Trial 2) improves physician proficiency compared with use of usual elicitation of signs and symptoms (Trial 1); both compare to confirmed nerve conduction abnormality.
目的 与早期使用“常见”体征和症状的试验（试验1）相比，采用“明确异常”的体征和症状重复临床与神经生理学（Cl vs N Phys）试验（试验2）。设计 试验1和试验2均使用标准和参考神经传导异常作为糖尿病感觉运动性多发性神经病的标准诊断指标。比较试验1和试验2中医师的诊断能力（评估者间的准确性）。地点 加拿大、丹麦、英国和美国的学术医疗中心。参与者 13名神经肌肉专家医师。试验2更换了1名专家。结果 试验2避免了试验1中明显的过度报告，尤其是体征方面。试验2中第1天和第2天诊断的可重复性显著更好（P = 0.005）。试验2中以下临床评分与涵盖正常和异常范围的复合神经传导测量值的相关性得到改善：针刺感觉（P = 0.03）、反射减弱（P = 0.06）、轻触觉感觉（P = 0.06）和症状总和（P = 0.06）。结论 在诊断糖尿病感觉运动性多发性神经病时（试验2），在临床判断中采用考虑年龄、性别和身体变量的明确异常体征和症状这一简单的预试验决策，与使用常见体征和症状的引出方法（试验1）相比，提高了医师的诊断能力；两者均与确诊的神经传导异常进行比较。
