Does specificity of electrodiagnostic test referrals predict test outcome in children?
John C McHugh1, Eileen O'Flaherty1, Nicole Daly1
1Department of Clinical Neurophysiology, Children's Health Ireland (CHI)-Crumlin, Dublin, Ireland.
Insights
Specificity in pediatric electrodiagnostic testing (EDX) referrals improves diagnostic accuracy. Lack of a pre-test diagnosis or referral for pain reduces the likelihood of abnormal EDX outcomes in children.
Area of Science:
- Pediatric Neurology
- Neuromuscular Disorders
- Diagnostic Testing
Background:
- Electrodiagnostic testing (EDX) is crucial for diagnosing pediatric neuromuscular diseases.
- Non-specific referrals are increasingly common reasons for EDX in children.
- The impact of referral specificity on EDX outcomes in pediatric patients requires investigation.
Purpose of the Study:
- To determine if referral specificity predicts electrodiagnostic testing outcomes in children.
- To analyze the relationship between pre-test diagnostic information and EDX results.
- To identify factors influencing the accuracy of EDX referrals in pediatric populations.
Main Methods:
- A 7-year audit (2013-2020) of EDX referrals and outcomes at CHI-Crumlin.
- Coding of pre-test details and comparison with EDX outcomes.
- Utilized multinomial logistic regression to analyze the data.
Main Results:
- Electrodiagnostic testing (EDX) was performed on 702 children; 36% lacked a specified pre-test diagnosis.
- Referral specificity and absence of pain predicted abnormal EDX outcomes.
- Accuracy of pre-test diagnoses was highest for suspected anterior horn cell disorders (67%).
- Referral accuracy and abnormal outcomes were negatively impacted by pain as a primary symptom.
Conclusions:
- Electrodiagnostic testing (EDX) provides valuable information in pediatric cases.
- A lack of specified working diagnosis or referral for pain decreases the probability of abnormal EDX findings.
- Improving referral specificity can enhance the diagnostic yield of EDX 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 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.
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