Interobserver agreement and validity of bedside 'positive signs' for functional weakness, sensory and gait disorders in conversion disorder: a pilot study
Interobserver agreement and validity of bedside 'positive signs' for functional weakness, sensory and gait disorders in conversion disorder: a pilot study
复制标题
DOI：
10.1136/jnnp-2013-307381
复制
发表时间：
2015-04-01
影响因子：
11
通讯作者：
Aybek, Selma
中科院分区：
文献类型：
--
作者：
Daum, Corinna;Gheorghita, Fulvia;Aybek, Selma
背景 转换障碍（CD）不再是一种排除性诊断。新的 DSM-V 标准强调了神经系统检查“阳性体征”的重要性。只有很少的体征经过验证，对其可靠性知之甚少。 目的 通过评估床边阳性体征的特异性、敏感性和评估者间的可靠性，检验床边阳性体征在诊断表现为无力、步态或感觉症状的 CD 中的临床价值。 患者和方法 对 20 名连续的 CD 患者和 20 名“有机”对照进行标准化视频记录的神经系统检查。十个先前验证的感觉和运动体征被分组在一个量表中。在一项试点验证研究中评估了 13 种额外的运动/感觉“阳性体征”、14 种步态模式和 1 种一般体征。此外，两名独立神经科医生对视频记录进行了盲法评估，以评估每个体征的评估者间可靠性（Cohen's kappa）。 结果 感觉运动量表得分 >= 4/14 显示 100% 的特异性（CI 85 至 100）和 95% 的敏感性（CI 85 至 100）。在其他测试的体征中，有 10 种在克罗恩病中出现的频率显着高于对照组。 23/38 个体征的观察者间一致性是可以接受的（2 个优秀，10 个良好，11 个中等）。 结论 我们的研究证实，6 个床边“阳性体征”对 CD 具有高度特异性，具有良好至优秀的评估者间可靠性；我们建议将它们视为“高度可靠的标志”。此外，13 个标志可被视为“可靠标志”，另外 6 个标志可被视为“暗示标志”，而所有其他标志应谨慎使用，直至获得进一步验证。
Background Conversion disorder (CD) is no longer a diagnosis of exclusion. The new DSM-V criteria highlight the importance of 'positive signs' on neurological examination. Only few signs have been validated, and little is known about their reliability.Objective The aim was to examine the clinical value of bedside positive signs in the diagnosis of CD presenting with weakness, gait or sensory symptoms by assessing their specificity, sensitivity and their inter-rater reliability.Patients and methods Standardised video recorded neurological examinations were performed in 20 consecutive patients with CD and 20 'organic' controls. Ten previously validated sensory and motor signs were grouped in a scale. Thirteen additional motor/sensory 'positive signs', 14 gait patterns and 1 general sign were assessed in a pilot validation study. In addition, two blinded independent neurologists rated the video recordings to assess the inter-rater reliability (Cohen's kappa) of each sign.Results A score of >= 4/14 on the sensory motor scale showed a 100% specificity (CI 85 to 100) and a 95% sensitivity (CI 85 to 100). Among the additional tested signs, 10 were significantly more frequent in CD than controls. The interobserver agreement was acceptable for 23/38 signs (2 excellent, 10 good, 11 moderate).Conclusions Our study confirms that six bedside 'positive signs' are highly specific for CD with good-excellent inter-rater reliability; we propose to consider them as 'highly reliable signs'. In addition 13 signs could be considered as 'reliable signs' and six further signs as 'suggestive signs' while all others should be used with caution until further validation is available.