University of Adelaide, Adelaide, SA, Australia.
Flinders Medical Centre, Bedford Park, SA, Australia.
Semin Ophthalmol. 2023 Oct;38(7):679-685. doi: 10.1080/08820538.2023.2194984. Epub 2023 Mar 26.
The diagnosis of myasthenia gravis (MG) may be challenging and require multiple specialised testing modalities. Accessing these investigations can involve significant waiting time and costs. The bedside icepack test (IPT) has been proposed to assist with the diagnosis of MG with ocular features, and may prove an economically viable; however, there have been there is heterogeneity in the literature evaluating the IPT.
A systematic review was performed examining the accuracy, described techniques, and economic implications of the IPT for the diagnosis of MG with ocular features.
The databases EMBASE, PubMed, and the Cochrane Library were searched from inception to July 2022. The systematic review adhered to PRISMA guidelines. Eligibility determination was undertaken with a standardised form using appropriate inclusion criteria. The Cochrane risk of bias assessment tool for diagnostic test accuracy was employed to evaluate studies that presented the diagnostic performance of the IPT. The Johanna Briggs Institute Critical Appraisal Checklist for Economic Evaluations was used for the assessment of studies presenting economic evaluations of the IPT.
20 articles met the specified criteria and included a total of 1264 participants. The IPT had a sensitivity ranging from 38.5% to 100%. Specificity was found to be > 95% in six studies. Excluding two outlier results of 25% and 31.3%, the lowest specificity recorded was 62.5%. The most commonly described method of evaluating the IPT involved applying ice to both eyelids and using a >2 mm change as a threshold for a positive test (evaluated with a ruler). There were no adverse effects described with the IPT. There were no studies that formally examined the economic implications of the IPT.
The IPT is a well-tolerated and readily available diagnostic tool that has an important role in the evaluation of possible MG with ocular features in specific contexts. Despite limited economic evaluation of this test, it is likely the use of the IPT may result in significant financial and time savings.
重症肌无力 (MG) 的诊断可能具有挑战性，需要多种专业的检测手段。进行这些检查可能需要等待很长时间并花费很多钱。床边冰袋试验 (IPT) 已被提议用于辅助诊断具有眼部特征的 MG，并且可能具有经济可行性；然而，评估 IPT 的文献存在异质性。
系统评价了床边冰袋试验在诊断具有眼部特征的 MG 中的准确性、描述的技术和经济意义。
从建库到 2022 年 7 月，检索了 EMBASE、PubMed 和 Cochrane 图书馆数据库。系统评价遵循 PRISMA 指南。使用适当的纳入标准，通过标准化表格进行资格确定。采用 Cochrane 诊断测试准确性风险偏倚评估工具评估了报告 IPT 诊断性能的研究。使用 Johanna Briggs 研究所经济评估批判性评价清单评估了报告 IPT 经济评估的研究。
20 篇文章符合指定标准，共纳入 1264 名参与者。IPT 的敏感性范围为 38.5%至 100%。6 项研究中发现特异性>95%。排除两项 25%和 31.3%的异常结果后，记录的最低特异性为 62.5%。最常描述的评估 IPT 的方法是在两个眼睑上敷冰，并使用>2mm 的变化作为阳性测试的阈值（用尺子评估）。IPT 无不良作用。没有研究正式评估 IPT 的经济意义。
IPT 是一种耐受性良好且易于获得的诊断工具，在特定情况下，在评估可能具有眼部特征的 MG 方面具有重要作用。尽管对该测试的经济评估有限，但使用 IPT 可能会带来显著的财务和时间节省。
