巴宾斯基征在识别锥体束功能障碍中的准确性。

Accuracy of the Babinski sign in the identification of pyramidal tract dysfunction.

作者信息

Isaza Jaramillo Sandra Patricia, Uribe Uribe Carlos Santiago, García Jimenez Francisco A, Cornejo-Ochoa William, Alvarez Restrepo Juan Felipe, Román Gustavo C

机构信息

Facultad de Medicina, Universidad de Antioquia, Carrera 51d N° 62-29, Medellín 050010, Colombia.

Facultad de Medicina, Universidad de Antioquia, Carrera 51d N° 62-29, Medellín 050010, Colombia; Hospital Universitario San Vicente Fundación, Calle 64N° 51d-154, Medellín 050010, Colombia; Neurologic institute of Colombia, Calle 55N° 46-36, Medellín 050010, Colombia.

出版信息

J Neurol Sci. 2014 Aug 15;343(1-2):66-8. doi: 10.1016/j.jns.2014.05.028. Epub 2014 May 21.

DOI:10.1016/j.jns.2014.05.028

PMID:24906707

Abstract

BACKGROUND

The extensor plantar response described by Joseph Babinski (1896) indicates pyramidal tract dysfunction (PTD) but has significant inter-observer variability and inconsistent accuracy. The goal of this study was to determine the accuracy of the Babinski sign in subjects with verified PTD.

METHODS

We studied 107 adult hospitalized and outpatient subjects evaluated by neurology. The reference standard was the blinded and independent diagnosis of an expert neurologist based on anamnesis, physical examination, imaging and complementary tests. Two neurologists elicited the Babinski sign in each patient independently, blindly and in a standardized manner to measure inter-observer variability; each examination was filmed to quantify intra-observer variability.

RESULTS

Compared with the reference standard, the Babinski sign had low sensitivity (50.8%, 95%CI 41.5-60.1) but high specificity (99%, 95%CI 97.7-100) in identifying PTD with a positive likelihood ratio of 51.8 (95%CI 16.6-161.2) and a calculated inter-observer variability of 0.73 (95%CI 0.598-0.858). The intraevaluator reliability was 0.571 (95%CI 0.270-0.873) and 0.467 (95%, CI 0.019-0.914) respectively, for each examiner.

CONCLUSION

The presence of the Babinski sign obtained by a neurologist provides valid and reliable evidence of PTD; due to its low sensitivity, absence of the Babinski sign still requires additional patient evaluation if PTD is suspected.

摘要

背景

约瑟夫·巴宾斯基（1896年）所描述的跖反射伸肌反应表明锥体束功能障碍（PTD），但观察者间存在显著差异且准确性不一致。本研究的目的是确定巴宾斯基征在已证实患有PTD的受试者中的准确性。

方法

我们研究了107名接受神经病学评估的成年住院和门诊患者。参考标准是由专家神经科医生根据病史、体格检查、影像学和辅助检查进行的盲法独立诊断。两名神经科医生以标准化方式独立、盲法地对每位患者引出巴宾斯基征，以测量观察者间差异；每次检查都进行录像以量化观察者内差异。

结果

与参考标准相比，巴宾斯基征在识别PTD时敏感性较低（50.8%，95%可信区间41.5 - 60.1），但特异性较高（99%，95%可信区间97.7 - 100），阳性似然比为51.8（95%可信区间16.6 - 161.2），计算得出的观察者间差异为0.73（95%可信区间0.598 - 0.858）。每位检查者的评估者内可靠性分别为0.571（95%可信区间0.270 - 0.873）和0.467（95%，可信区间0.019 - 0.914）。