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Signs and symptoms versus nerve conduction studies to diagnose diabetic sensorimotor polyneuropathy: Cl vs. NPhys trial
Author(s) -
Dyck Peter J.,
Overland Carol J.,
Low Phillip A.,
Litchy William J.,
Davies Jenny L.,
Dyck P. James B.,
O'Brien Peter C.
Publication year - 2010
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/mus.21661
Subject(s) - medicine , polyneuropathy , diabetes mellitus , nerve conduction study , abnormality , gold standard (test) , medical diagnosis , nerve conduction , physical therapy , diabetic neuropathy , surgery , radiology , endocrinology , psychiatry
The purpose was to test whether physicians can validly and reproducibly diagnose diabetic sensorimotor polyneuropathy (DSPN). Twelve physicians assessed 24 patients with diabetes mellitus (DM) on consecutive days (576 examinations) with physical features and voice disguised. Results were compared to gold standard 75% group diagnosis (dx) and a nerve conduction score (Σ5 NC nds). Masking of patients was achieved. Reproducibility measured by the kappa coefficient and compared to Σ5 NC nd varied considerably among physicians: median and ranges: signs 0.8 (0.32–1.0); symptoms 0.79 (0.36–1.0), and diagnoses 0.47 (0.33–0.84), both low and high scores indicating poor performance. There was substantial agreement between 75% group dx and confirmed NC abnormality (abn). As compared to Σ5 NC, individual physicians' clinical dx was excessively variable and frequently inaccurate. Study physician dx from signs and symptoms were excessively variable, often overestimating DSPN. Specific approaches to improving clinical proficiency should be tested. Muscle Nerve 42:157–164, 2010