Data Gap in Sacral Neuromodulation Documentation: Call to Improve Documentation Protocols.
Data Gap in Sacral Neuromodulation Documentation: Call to Improve Documentation Protocols.
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DOI：
10.5213/inj.2244084.042
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发表时间：
2022-09
影响因子：
2.3
通讯作者：
Nelson DE
中科院分区：
文献类型：
--
作者：
Hornung CM;Vasdev R;Hanson KA;Gotlieb R;Fok CS;Fischer J;Nakib NA;Nelson DE
我们量化了我们机构的骶神经调节（SNM）阈值测试和编程参数的患者记录，以确定改善治疗结果和未来SNM技术的机会。回顾性分析了40例SNM患者的127例记录。筛选SNM文件记录，包括定性和定量数据。定性包括阈值测试的间接参考，定量包括患者使用的疗效描述和设备编程。结果根据就诊类型分类：经皮神经评估（PNE）、1期（S1）、永久性铅植入、2期（S2）永久性脉冲发生器植入、器械相关随访或手术切除。阈值测试的记录在首次种植访视（PNE和S1）时更完整，在第2次访视时不完整，随访临床访视时很少。手术运动阈值通常只使用定性评价，如“良好反应”（PNE， S1为88%，100%），较少使用定量值（68%,84%），反应位置（84%,83%）或用于测试的特定接触者（0%）。S2运动阈值的定性、定量和解剖定位结果记录较少，分别为70%、48%和36%。手术记录不包括具体的刺激参数或用于测试的接触。术后感觉测试通常仅定性（80%，PNE， S1为67%），定量值记录的频率要低得多（39%,9%），并且通常缺乏感觉位置或电极特异性结果。对于随访，<10%包括定量感官测试结果。很少有记录（<7%）包括推荐的治疗递送设备程序设置，没有记录包括治疗使用日志。虽然有证据表明接触和特定参数的规划可以改善SNM治疗结果，但在这些数据的文献中存在重大差距。更详细的测试和文档可以改善参数滴定的治疗选择，并为未来的技术提供设计输入。
We quantified patient record documentation of sacral neuromodulation (SNM) threshold testing and programming parameters at our institution to identify opportunities to improve therapy outcomes and future SNM technologies. A retrospective review was conducted using 127 records from 40 SNM patients. Records were screened for SNM documentation including qualitative and quantitative data. The qualitative covered indirect references to threshold testing and the quantitative included efficacy descriptions and device programming used by the patient. Findings were categorized by visit type: percutaneous nerve evaluation (PNE), stage 1 (S1), permanent lead implantation, stage 2 (S2) permanent impulse generator implantation, device-related follow-up, or surgical removal. Documentation of threshold testing was more complete during initial implant visits (PNE and S1), less complete for S2 visits, and infrequent for follow-up clinical visits. Surgical motor thresholds were most often referred to using only qualitative comments such as “good response” (88%, 100% for PNE, S1) and less commonly included quantitative values (68%, 84%), locations of response (84%, 83%) or specific contacts used for testing (0%). S2 motor thresholds were less well documented with qualitative, quantitative, and anatomical location outcomes at 70%, 48%, and 36% respectively. Surgical notes did not include specific stimulation parameters or contacts used for tests. Postoperative sensory tests were often only qualitative (80%, 67% for PNE, S1) with quantitative values documented much less frequently (39%, 9%) and typically lacked sensory locations or electrode-specific results. For follow-up visits, <10% included quantitative sensory test outcomes. Few records (<7%) included device program settings recommended for therapy delivery and none included therapy-use logs. While evidence suggests contact and parameter-specific programming can improve SNM therapy outcomes, there is a major gap in the documentation of this data. More detailed testing and documentation could improve therapeutic options for parameter titration and provide design inputs for future technologies.
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