"Unequivocally Abnormal" vs "Usual" Signs and Symptoms for Proficient Diagnosis of Diabetic Polyneuropathy Cl vs N Phys Trial
"Unequivocally Abnormal" vs "Usual" Signs and Symptoms for Proficient Diagnosis of Diabetic Polyneuropathy Cl vs N Phys Trial
复制标题
DOI：
10.1001/archneurol.2012.1481
复制
发表时间：
2012-12-01
影响因子：
--
通讯作者：
Vella, Adrian
中科院分区：
文献类型：
--
作者：
Dyck, Peter J.;Overland, Carol J.;Vella, Adrian
目的：重复临床与神经生理学（Cl与N Phys）试验使用“明确异常”的体征和症状（试验2）与早期试验（试验1），其中使用“通常”的体征和症状相比，设计：标准和参考神经传导异常，在试验1和2中使用的标准标准，指示糖尿病感觉运动性多发性神经病。比较了试验1和2的医师熟练程度（评估者的准确性）。地点：加拿大、丹麦、英国和美国的学术医学中心。参与者：13名神经肌肉专家医师。结果：试验1中的明显多报，特别是体征的多报，在试验2中得以避免。在试验2中，第1天和第2天之间的诊断再现性显著更好（P=.005）。在试验2中，以下临床评分与跨越正常和异常范围的复合神经传导测量的相关性得到改善：（P= 0.03）反射减少（P=.06），触压感（P= 0.06），症状的总和（P=.06）.结论：简单的审前决定，使用明确的异常体征和服用年龄，性别，和物理变量-在诊断糖尿病感觉运动性多发性神经病的临床判断中（试验2）与使用通常的体征和症状的引出（试验1）相比提高了医生的熟练程度;两者都与确认的神经传导异常相比较。神经弓2012; 69（12）：1609-1614. 2012年9月17日在线发布。doi：10.1001/archneurol.2012.1481
Objective: To repeat the Clinical vs Neurophysiology (Cl vs N Phys) trial using "unequivocally abnormal" signs and symptoms (Trial 2) compared with the earlier trial (Trial 1), which used "usual" signs and symptoms.Design: Standard and referenced nerve conduction abnormalities were used in both Trials 1 and 2 as the standard criterion indicative of diabetic sensorimotor polyneuropathy. Physician proficiency (accuracy among evaluators) was compared between Trials 1 and 2.Setting: Academic medical centers in Canada, Denmark, England, and the United States.Participants: Thirteen expert neuromuscular physicians. One expert was replaced in Trial 2.Results: The marked overreporting, especially of signs, in Trial 1 was avoided in Trial 2. Reproducibility of diagnosis between days 1 and 2 was significantly (P=.005) better in Trial 2. The correlation of the following clinical scores with composite nerve conduction measures spanning the range of normality and abnormality was improved in Trial 2: pinprick sensation (P=.03), decreased reflexes (P=.06), touch-pressure sensation (P=.06), and the sum of symptoms (P=.06).Conclusions: The simple pretrial decision to use unequivocally abnormal signs and symptoms-taking age, sex, and physical variables into account-in making clinical judgments for the diagnosis of diabetic sensorimotor polyneuropathy (Trial 2) improves physician proficiency compared with use of usual elicitation of signs and symptoms (Trial 1); both compare to confirmed nerve conduction abnormality. Arch Neurol. 2012; 69(12): 1609-1614. Published online September 17, 2012. doi:10.1001/archneurol.2012.1481