Smith Brandon H, Koshinski Jessica L, Ozdag Yagiz, Mahmoud Mahmoud, Garcia Victoria C, Dwyer C Liam, Klena Joel C, Grandizio Louis C
Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA.
Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA.
J Hand Surg Am. 2025 Jul;50(7):797-804. doi: 10.1016/j.jhsa.2025.03.011. Epub 2025 May 13.
Preconsultation electrodiagnostic studies (EDS) are used frequently by hand surgeons. However, EDS can increase health care expenditures and delay access to subspeciality care. Our purpose was to assess the validity of a modified, telephone-based versions of the CTS-6 (the "CTS-3T" and "CTS-2T") in determining a preconsultation diagnosis of carpal tunnel syndrome (CTS).
Adult patients scheduled via telephone for an outpatient upper extremity visit were administered the telephone screening instrument by a clinic scheduler. Patients were asked the 2 history components of the CTS-6 (subjective numbness and nocturnal symptoms) and instructed on how to perform the Phalen test. Points assigned to individual phone questions were the same as in the CTS-6. The CTS-6 data from a prior study were used to determine diagnostic thresholds for phone instruments. The 2-item CTS-2T consisted of both history questions and the 3-item CTS-3T also included the Phalen test. Following telephone administration by a clinic scheduler, 1 of 3 hand surgeons administered the CTS-6 during clinic, which served as the reference standard. Sensitivity (Sn), specificity (Sp) and agreement (Cohen's κ) for the CTS-2T and 3T were calculated.
A total of 178 patients were included and 36% had CTS based on the results of the CTS-6. The CTS-2T had a Sn/Sp of 78%/88% whereas for the CTS-3T it was 77%/83%, respectively. Agreement between schedulers and surgeons for diagnosis of CTS was moderate (κ = 0.59; 95% confidence interval, 0.47-0.71) for CTS-3T and substantial for CTS-2T (κ = 0.68; 95% confidence interval, 0.54-0.77). Agreement for the Phalen test was the lowest of the 3 items (κ = 0.18, slight).
The CTS-2T demonstrated a Sn/Sp of 78%/88% with substantial agreement for the diagnosis of CTS. With high Sn/Sp, surgeons who routinely require preconsultations EDS should consider incorporating the CTS-2T into scheduling pathways, as this telephone screening instrument can accurately identify patients with suspected CTS.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.
手外科医生经常使用术前电诊断研究（EDS）。然而，EDS会增加医疗保健支出并延迟获得专科护理的机会。我们的目的是评估改良的基于电话的CTS-6版本（“CTS-3T”和“CTS-2T”）在确定腕管综合征（CTS）术前诊断方面的有效性。
通过电话预约门诊上肢就诊的成年患者由诊所调度员进行电话筛查工具测试。询问患者CTS-6的2个病史组成部分（主观麻木和夜间症状），并指导他们如何进行Phalen试验。分配给各个电话问题的分数与CTS-6中的相同。来自先前研究的CTS-6数据用于确定电话工具的诊断阈值。2项的CTS-2T包括两个病史问题，3项的CTS-3T还包括Phalen试验。在诊所调度员进行电话测试后，3名手外科医生中的1名在诊所期间进行CTS-6测试，将其作为参考标准。计算CTS-2T和3T的敏感性（Sn）、特异性（Sp）和一致性（Cohen'sκ）。
共纳入178例患者，根据CTS-6结果，36%的患者患有CTS。CTS-2T的Sn/Sp为78%/88%，而CTS-3T的Sn/Sp分别为77%/83%。调度员和外科医生对CTS诊断的一致性对于CTS-3T为中等（κ=0.59；95%置信区间，从0.47至0.71），对于CTS-2T为高度一致（κ=0.68；95%置信区间，从0.54至0.77）。Phalen试验的一致性在3项中最低（κ=0.18，轻微）。
CTS-2T的Sn/Sp为78%/88%，对CTS诊断具有高度一致性。鉴于其高Sn/Sp，经常需要术前EDS的外科医生应考虑将CTS-2T纳入调度流程，因为这种电话筛查工具可以准确识别疑似CTS的患者。
研究类型/证据水平：诊断性II级。
