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Requests for electromyography in Rome: a critical evaluation.

Roberto Di Fabio, Claudio Castagnoli, Andrea Madrigale

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    Many electromyography examinations (EMGs) in Rome lack specific queries, leading to low diagnostic concordance. Over 17% of EMGs were deemed useless, suggesting suboptimal prescription practices for these neurophysiological tests.

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    Area of Science:

    • Neuroscience
    • Clinical Electrophysiology

    Background:

    • Electromyography examinations (EMGs) are crucial diagnostic tools in neurophysiology.
    • Data on the appropriateness of EMG request suitability in Rome is lacking.
    • Understanding referral patterns and diagnostic yield is essential for optimizing healthcare resource allocation.

    Purpose of the Study:

    • To evaluate the suitability and diagnostic yield of electromyography (EMG) requests in Rome.
    • To analyze the concordance between clinical suspicion and EMG findings.
    • To identify factors influencing the diagnostic utility of EMGs.

    Main Methods:

    • Retrospective analysis of 1,317 EMG records from 1,220 consecutive patients in two Rome-based neurophysiology labs.
    • Data collected included patient demographics, referring physician specialty, clinical diagnosis, and EMG results.
    • Statistical analysis was performed to assess concordance rates and diagnostic utility.

    Main Results:

    • The majority of EMG requests (57%) originated from general practitioners, followed by orthopedic specialists (18%).
    • Commonly investigated conditions included L4-L5 radiculopathy and carpal tunnel syndrome.
    • A significant proportion of requests (68%) lacked specific queries, resulting in low diagnostic concordance (<20%).
    • When specific queries were provided, EMG confirmed initial suspicions in 54% of GP requests and 64% of specialist requests.
    • Neurophysiologists deemed 17% of EMGs diagnostically useless, indicating potential over-prescription or inappropriate utilization.

    Conclusions:

    • A substantial percentage of EMG requests in Rome are suboptimal, characterized by a lack of specific diagnostic queries.
    • Improved communication and clearer referral indications could enhance the diagnostic value of EMGs.
    • There is a need for better physician education on appropriate EMG utilization to improve diagnostic accuracy and resource efficiency.