Bembenek Jan P, Sobańska Anna, Litwin Tomasz
Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland.
Postep Psychiatr Neurol. 2023 Mar;32(1):18-22. doi: 10.5114/ppn.2023.127234. Epub 2023 May 8.
Access to electroneurographic/electromyographic (ENG/EMG) examinations and the number of patients referred for electrodiagnostic (EDX) examination are increasing. We aimed to determine the accuracy of the initial clinical diagnosis made by outpatient medical care physicians who referred patients to the EMG laboratory.
We analyzed referrals and EDX results of all patients who visited EMG laboratory of the Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology in Warsaw in 2021. Examinations were performed in accordance with the standards and norms adopted in our laboratory by EMG-certified neurologists, regarding the initial diagnosis stated by referring physicians.
A total of 454 EDX results from 412 patients were analyzed. Most of patients (54.6%) were referred with diagnosis of carpal tunnel syndrome (CTS), followed by single nerves damage (18.7%), polyneuropathy (18.1%), tetany (7.0%), myasthenia gravis (1.3%) or myopathy (0.2%). The result of the ENG/EMG examination was: diagnosis confirmation (61.9%), a new clinically significant diagnosis or additional asymptomatic nerve damage (32.4%), and normal examination result (25.1%) of patients. Electrophysiological examination most often confirmed the referral diagnosis in patients with suspected CTS (75.4%), followed by single nerves damage (51.8%), polyneuropathy (48.8%), tetany (31.3%) and the least for myasthenia gravis and myopathy (0%).
Our study showed frequent inconsistency of the EDX results with the clinical diagnosis formed by the referring physician. A high percentage of normal test results was noted. Initial diagnosis and the scope of EDX examination should be determined by detailed interview and physical examination.
接受神经电图/肌电图（ENG/EMG）检查的机会以及被转诊进行电诊断（EDX）检查的患者数量正在增加。我们旨在确定将患者转诊至肌电图实验室的门诊医疗医生做出的初始临床诊断的准确性。
我们分析了2021年访问华沙精神病学和神经病学研究所临床神经生理学系肌电图实验室的所有患者的转诊情况和EDX结果。检查是由获得肌电图认证的神经科医生按照我们实验室采用的标准和规范进行的，涉及转诊医生给出的初始诊断。
共分析了412例患者的454份EDX结果。大多数患者（54.6%）被转诊时诊断为腕管综合征（CTS），其次是单神经损伤（18.7%）、多发性神经病（18.1%）、手足搐搦症（7.0%）、重症肌无力（1.3%）或肌病（0.2%）。ENG/EMG检查结果为：诊断确认（61.9%）、新的具有临床意义的诊断或额外的无症状神经损伤（32.4%）以及患者检查结果正常（25.1%）。电生理检查最常确认疑似CTS患者的转诊诊断（75.4%），其次是单神经损伤（51.8%）、多发性神经病（48.8%）、手足搐搦症（31.3%），而重症肌无力和肌病的确认率最低（0%）。
我们的研究表明，EDX结果与转诊医生形成的临床诊断经常不一致。注意到正常检查结果的比例很高。初始诊断和EDX检查的范围应由详细的问诊和体格检查来确定。
