Zhuang Thompson, Shapiro Lauren M, Schultz Emily A, Truong Nicole M, Harris Alex H S, Kamal Robin N
VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, CA.
J Hand Surg Am. 2023 Jan;48(1):19-27. doi: 10.1016/j.jhsa.2022.09.019. Epub 2022 Nov 29.
A 2016 American Academy of Orthopaedic Surgeons (AAOS) clinical practice guideline (CPG) de-emphasized the need for electrodiagnostic studies (EDS) for carpal tunnel syndrome (CTS). We tested the hypothesis that use of EDS decreased after the AAOS CPG.
Using a national administrative claims database, we measured the proportion of patients with a diagnosis of CTS who underwent EDS within 1 year after diagnosis between 2011 and 2019. Using an interrupted time series design, we defined 2 time periods (pre-CPG and post-CPG) and compared EDS usage between the periods using segmented regression analysis. We conducted a subgroup analysis of preoperative EDS usage in patients who underwent carpal tunnel release.
Of 2,081,829 patients with CTS, 315,449 (15.2%) underwent EDS within 1 year after diagnosis. The segmented regression analysis showed a decrease in the level of EDS usage after publication of the AAOS CPG (-11.50 per 1,000 patients [95% CI, -1.47 to -0.95 per 1,000 patients]); however, the rate of EDS usage increased in the post-CPG period (+1.75 per 1,000 patients per quarter [95% CI, 0.97-2.54 per 1,000 patients per quarter]). Of 473,753 eligible patients who underwent carpal tunnel release, 139,186 (29.4%) underwent EDS within 6 months before surgery. After publication of the AAOS CPG, preoperative EDS usage decreased by -23.57 per 1,000 patients (95% CI, -37.72 to -9.42 per 1,000 patients). However, these decreasing trends in EDS usage predated the 2016 AAOS CPG.
The overall and preoperative EDS usage for CTS has been decreasing since at least 2014, predating the 2016 AAOS CPG, reflecting the rapid implementation of evidence into practice. However, EDS usage has increased in the post-CPG period, and a considerable proportion of patients who underwent carpal tunnel release still received EDS.
Given its high costs and disputed value, routine EDS usage should be considered for further deimplementation initiatives.
2016年美国骨科医师学会（AAOS）临床实践指南（CPG）不再强调腕管综合征（CTS）患者进行电诊断检查（EDS）的必要性。我们检验了一个假设，即AAOS临床实践指南发布后，EDS的使用减少。
利用一个全国性的行政索赔数据库，我们测量了2011年至2019年期间诊断为CTS的患者在诊断后1年内接受EDS检查的比例。采用中断时间序列设计，我们定义了两个时间段（CPG发布前和CPG发布后），并使用分段回归分析比较两个时间段内EDS的使用情况。我们对接受腕管松解术的患者术前EDS使用情况进行了亚组分析。
在2,081,829例CTS患者中，315,449例（15.2%）在诊断后1年内接受了EDS检查。分段回归分析显示，AAOS临床实践指南发布后，EDS的使用水平有所下降（每1000例患者减少11.50例[95%CI，每1000例患者减少1.47至0.95例]）；然而，在CPG发布后的时期，EDS的使用速率有所增加（每季度每1000例患者增加1.75例[95%CI，每季度每1000例患者增加0.97 - 2.54例]）。在473,753例符合条件并接受腕管松解术的患者中，139,186例（29.4%）在手术前6个月内接受了EDS检查。AAOS临床实践指南发布后，术前EDS的使用量每1000例患者减少了23.57例（95%CI，每1000例患者减少37.72至9.42例）。然而，这些EDS使用量的下降趋势在2016年AAOS临床实践指南发布之前就已经存在。
至少自2014年以来，CTS患者的总体和术前EDS使用量一直在下降，早于2016年AAOS临床实践指南，这反映了证据在实践中的快速应用。然而，在CPG发布后的时期，EDS的使用量有所增加，并且相当一部分接受腕管松解术的患者仍然接受了EDS检查。
鉴于其高成本和有争议的价值，应考虑进一步采取措施减少常规EDS的使用。
