Optimizing Electrodiagnostic Studies: The Role of Clinical History in Improving Diagnostic Concordance-A
Carlos Omar López-López1, Mónica Touron De Alba2, María de la Luz Montes-Castillo2
1Applied Research and Technology Institute (InIAT), Universidad Iberoamericana-Ciudad de México, Mexico City 01219, Mexico.
Abstract:
Background: Electrodiagnostic (EDx) studies are crucial for diagnosing neuromuscular diseases and are considered a complement to neurological examinations. Their effectiveness is highly dependent on the quality of the initial clinical diagnosis, medical history, and physical examination. This study aims to evaluate the concordance between clinical diagnoses and EDx findings, and to identify the primary specialties and clinical data justifying EDx referrals. Methods: This retrospective study included data from referral forms and EDx reports for nerve conduction studies and electromyography at Hospital General de México "Dr. Eduardo Liceaga" from January 2022 to January 2023. Statistical analyses involved descriptive statistics, Cohen's Kappa coefficient, and binary logistic regression to assess diagnostic concordance and the influence of clinical symptoms. Results: Out of 1065 referral requests, 61.8% had their clinical diagnosis confirmed through EDx studies. Most requests originated from orthopedics (25.7%), rheumatology (17.5%), and neurology (17.4%). Although 79.5% of requests included symptoms, only 32.1% included a physical examination. Common diagnoses included radiculopathy (34.6%), polyneuropathy (22.7%), and carpal tunnel syndrome (22.4%). Concordance between clinical and electrophysiological diagnoses had a coefficient of 0.578 (95% CI: 0.537-0.619; p < 0.001). Pain and weakness were significantly associated with diagnostic confirmation (pain: OR 3.1; 95% CI: 1.79-5.48; p < 0.001; weakness: OR 2.46; 95% CI: 1.35-4.48; p = 0.003). Neurology had the highest concordance (0.853; 95% CI: 0.829-0.878), while neurosurgery had the lowest (0.502; 95% CI: 0.378-0.627). Conclusions: EDx studies are valuable, yet their concordance with clinical diagnoses is limited. The experience of the requesting physician significantly impacts diagnostic accuracy. Enhancing referral information is essential for improving EDx study effectiveness and reducing unnecessary procedures, thereby improving patient outcomes and managing costs.
