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. 2022 May;65(5):513-520.
doi: 10.1002/mus.27515. Epub 2022 Mar 11.

Does specificity of electrodiagnostic test referrals predict test outcome in children?

John C McHugh  1 , Eileen O'Flaherty  1 , Nicole Daly  1
Affiliations

Does specificity of electrodiagnostic test referrals predict test outcome in children?

John C McHugh et al. Muscle Nerve. 2022 May.

Abstract

Introduction/aims: Electrodiagnostic testing (EDX) is important in evaluation of pediatric neuromuscular disease. Non-specific referrals have emerged as a leading reason for EDX in recent years. We examine whether referral-specificity is predictive of test outcomes in children.

Methods: EDX referrals and outcomes were audited over a 7-year period from 2013 to 2020 at CHI-Crumlin. Pre-test details were coded and compared to EDX outcomes using multinomial logistic regression.

Results: EDX studies were performed in 702 children (median age 10.2 years). In 36% of patients, EDX-referrals did not specify any pre-test diagnosis. Mononeuropathy (24%) and polyneuropathy (15%) were the leading pre-specified diagnoses as well as the most common test outcomes. Neurology and orthopedics/plastic surgery contributed the majority of referrals. Metabolic medicine and hematology/oncology were most likely to pre-specify a working diagnosis and were the specialties with both the highest proportion of abnormal outcomes and referral accuracy. EDX abnormality was present in 42% of patients and was predicted by specificity of referral and the absence of pain as a leading symptom. The accuracy of specified pre-test diagnoses was highest for suspected anterior horn cell disorders (67%). Accuracy of referrals, as well as abnormal test outcomes, were negatively predicted by the presence of pain as a leading symptom.

Discussion: EDX is informative in children but the likelihood of abnormal test-outcomes is diminished when a pre-specified working diagnosis is lacking or when the primary reason for referral is pain.

Keywords: EMG; accuracy; electrodiagnostics; pediatric; specificity.

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References

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