Avtor/Urednik		Podnar, Simon
Naslov		Kritična analiza napotitev na elektrodiagnostično preiskavo perifernega živčevja
Prevedeni naslov		Critical analysis of referrals to electrodiagnostic examination of the peripheral nervous system
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 72, št. 4
Leto izdaje		2003
Obseg		str. 205-12
Jezik		slo
Abstrakt		Background. Clinical neurophysiologists observe a large number of examinees referred to a electromyographic (EMG) laboratory without clinical symptoms or signs of the peripheral nervous system lesion. Such referrals do not improve management of patients, but only unnecessarily burden examinees and laboratory personnel. The aim of the present study was to check appropriateness of referrals to electrodiagnostic examination, look for reasons for problems and suggest possible improvements. Methods. From the database of the Institute of Clinical Neurophysiology in Ljubljana all examinees evaluated by the author in a "general" EMG laboratory in the first 4 months of 2002 were included. From data about examinees, referral doctors, referral diagnoses, clinical symptoms and signs and electrophysiological findings, predictive values for neurological referral diagnoses and electrodiagnostic abnormalities were calculated using descriptive and multivariate statistical analyses. Results. Three hundred examinees (42% men) were included. Neurological diagnosis was provided in 55% of referrals. Electrodiagnostic abnormalities were found in 45% of examinees (carpal tunnel syndrome 50% radiculopathy 25%, other mononeuropathies 15%, polineuropathy 9%). In 9% of examinees only clinical, and in 47% neither clinical nor electrodiagnostic abnormalities were demonstrated. Using a multivariate analysis positive effect of referral with neurological diagnosis, of paraesthesiae and findings of weakness and sensory loss, and negative effect of pain and referral diagnosis cervicobrachialgia or lumboischialgia on pathological electrodiagnostic findings were found. Isolated pain and paraesthesiae (with carpal tunnel syndrome excluded) were particularly poor predictors of abnormal electrodiagnostic findings (9% and 16%, respectively). With exception of 20 patients with carpal tunnel syndrome, none with normal clinical neurological examination had abnormal electrodiagnostic findings.
Izvleček		Izhodišča. Pri delu v elektromiografski (EMG) ambulanti klinični nevrofiziologi opažamo številne napotitve preiskovancev brez okvare perifernega živčevja. Tovrstne napotitve ne izboljšujejo obravnave bolnikov, ampak preiskovance in zdravstveno osebje po nepotrebnem obremenjujejo. Namen naše raziskave je bil na reprezentativnem vzorcu preveriti ustreznost napotitev na elektrodiagnostične preiskave, poiskati vzroke za morebitne slabosti in predlagati možne rešitve. Metode. V raziskavi smo iz arhiva Inštituta za klinično nevrofiziologijo v Ljubljani izbrali vse preiskovance, ki jih je avtor pregledal v "splošni" EMG ambulanti v prvi tretjini leta 2002. S pomočjo opisne in multivariantne statistike smo iz zbranih podatkov izračunali napovedne dejavnike za oblikovanje nevrološke napotne diagnoze in za patološke izvide elektrodiagnostičnih preiskav. Rezultati. V raziskavo smo vključili 300 preiskovancev, 42% moških. Z nevrološko diagnozo je bilo napotenih 55% preiskovancev. Okvaro perifernega živčevja smo elektrodiagnostično potrdili pri 45% preiskovancev (sindrom zapestnega prehoda 50%, radikulopatijo 25%, ostale mononevropatije 15%, polinevropatijo 9%). Pri 9% preiskovancev smo našli le klinične, pri 47% pa ne kliničnih in ne elektrofizioloških znakov okvare. Z multivariantno analizo smo našli pozitiven vpliv napotitve z nevrološko diagnozo, navedbe mravljinčenja in najdbe šibkosti ali motene senzibilitete ter negativen vpliv navedbe bolečin in napotne diagnoze cervikobrahialgija ali lumboishialgija na patološki elektrodiagnostični izvid. Napovedna vrednost izoliranih bolečin in ob izključitvi sindroma zapestnega prehoda tudi mravljinčenja je bila nizka (9% in 16% patoloških preiskav). Z izjemo 20 preiskovancev s sindromom zapestnega prehoda pri nobenem od preiskovancev z normalnim kliničnim nevrološkim izvidom nismo našli elektrodiagnostične abnormnosti.
Deskriptorji		ELECTROMYOGRAPHY PERIPHERAL NERVOUS SYSTEM DISEASES NEUROLOGIC EXAMINATION RADICULITIS BRACHIAL PLEXUS NEURITIS LOW BACK PAIN CARPAL TUNNEL SYNDROME POLYNEURITIS