The Erasmus-Polyneuropathy Symptom Score for the Screening of Chronic Axonal Polyneuropathy: A Validation Study

Chronic axonal polyneuropathy is a common disorder that often remains undiagnosed. Early detection may enhance treatment of underlying risk factors and prevent long-term complications. The Erasmus-Polyneuropathy symptom score (E-PSS) is a simple and rapid screening tool, consisting of six questions (score ranges 0-14). This study aims to validate the E-PSS in a non-academic population and compare its performance with the commonly used Michigan Neuropathy Screening Instrument questionnaire (MNSIq).

This validation study was performed at two non-academic neurology outpatient clinics in the Netherlands. Patients visiting the outpatient clinic, regardless of the reason for referral, were eligible for inclusion if aged ≥ 18 years and able to fill in the questionnaire. The gold standard definition of chronic axonal polyneuropathy was based on the diagnosis made by the treating physician. The discriminative performance was evaluated using the area under the curve (AUC) of the receiver operating curves (ROC).

From February 2020 until October 2021, 818 participants were included, of whom 222 had chronic axonal polyneuropathy (27%). Median age was 62 years (IQR 49-73) and 59% were female (N = 479). The median E-PSS score in participants with polyneuropathy was 6 (IQR 3-8) and in participants without polyneuropathy 1 (IQR 0-4). The performance of the E-PSS was good (AUC 0.81, 95% CI 0.77-0.84) and better than the MNSIq (AUC 0.65, 95% CI 0.61-0.69) (The DeLong test; p < 0.001).

The E-PSS is a fast and easy-to-use questionnaire with good AUC-determined discriminative performance between participants with and without chronic axonal polyneuropathy in non-academic neurology outpatient settings.