Does specificity of electrodiagnostic test referrals predict test outcome in children?

Introduction/Aims Electrodiagnostic testing (EDX) is important in evaluation of pediatric neuromuscular disease. Non‐specific referrals have emerged as a leading reason for EDX in recent years. We examine whether referral‐specificity is predictive of test outcomes in children. Methods EDX referrals...

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Bibliographic Details
Published in:Muscle & nerve 2022-05, Vol.65 (5), p.513-520
Main Authors: McHugh, John C., O'Flaherty, Eileen, Daly, Nicole
Format: Article
Language:English
Subjects:
Accuracy
Child
Children
Diagnosis
Electrodiagnosis
electrodiagnostics
EMG
Hematology
Humans
Neuralgia
Neurology
Neuromuscular diseases
Neuromuscular Diseases - diagnosis
Neuroplasticity
Orthopedics
Pain
Patients
pediatric
Pediatrics
Peripheral nervous system
Physical Examination
Plastic surgery
Polyneuropathy
Referral and Consultation
specificity
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Summary:Introduction/Aims Electrodiagnostic testing (EDX) is important in evaluation of pediatric neuromuscular disease. Non‐specific referrals have emerged as a leading reason for EDX in recent years. We examine whether referral‐specificity is predictive of test outcomes in children. Methods EDX referrals and outcomes were audited over a 7‐year period from 2013 to 2020 at CHI‐Crumlin. Pre‐test details were coded and compared to EDX outcomes using multinomial logistic regression. Results EDX studies were performed in 702 children (median age 10.2 years). In 36% of patients, EDX‐referrals did not specify any pre‐test diagnosis. Mononeuropathy (24%) and polyneuropathy (15%) were the leading pre‐specified diagnoses as well as the most common test outcomes. Neurology and orthopedics/plastic surgery contributed the majority of referrals. Metabolic medicine and hematology/oncology were most likely to pre‐specify a working diagnosis and were the specialties with both the highest proportion of abnormal outcomes and referral accuracy. EDX abnormality was present in 42% of patients and was predicted by specificity of referral and the absence of pain as a leading symptom. The accuracy of specified pre‐test diagnoses was highest for suspected anterior horn cell disorders (67%). Accuracy of referrals, as well as abnormal test outcomes, were negatively predicted by the presence of pain as a leading symptom. Discussion EDX is informative in children but the likelihood of abnormal test‐outcomes is diminished when a pre‐specified working diagnosis is lacking or when the primary reason for referral is pain. See Editorial on pages 492–494 in this issue
ISSN:0148-639X
1097-4598
DOI:10.1002/mus.27515