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A Quality Collaborative Study of the Concordance of Electrodiagnostic Scores and Clinical Severity in Carpal Tunnel Syndrome.

Publication ,  Journal Article
Billig, JI; Kotsis, SV; Ouyang, Z; Wang, L; Chung, KC; Michigan Collaborative Hand Initiative for Quality in Surgery Collaborators, ...
Published in: Plast Reconstr Surg
December 1, 2022

BACKGROUND: Electrodiagnostic studies are commonly used to diagnose carpal tunnel syndrome. However, these examinations are prone to false-positive and false-negative values. The authors evaluated the agreement of electrodiagnostic study severity, clinical assessment scores, and probability of carpal tunnel syndrome [Six-Item Carpal Tunnel Syndrome Evaluation Tool (CTS-6) scores. METHODS: This was a retrospective cohort study of 609 patients with carpal tunnel syndrome (941 hands). Data were collected from nine hand surgery practices in the Michigan Collaborative Hand Initiative for Quality in Surgery. Goodman and Kruskal gamma statistics (γ) measured the agreement between electrodiagnostic studies and clinical assessment scores and between electrodiagnostic studies and CTS-6 scores. The authors performed cumulative logistic regression with mixed effects to evaluate the association among electrodiagnostic study severity, clinical assessments, and patient characteristics. RESULTS: The concordance between electrodiagnostic study severity and CTS-6 scores was γ = 0.31 (95 percent CI, 0.21 to 0.40), with an accuracy of 43 percent. The concordance between electrodiagnostic study severity and clinical assessment scores was γ = 0.66 (95 percent CI, 0.58 to 0.74), with an accuracy of 58 percent. Wide site-level variation in the γ coefficient between electrodiagnostic studies and clinical assessment scores and between electrodiagnostic studies and CTS-6 was seen. Male sex, increasing age, and increasing body mass index were significantly associated with increased odds of electrodiagnostic study severity. CONCLUSIONS: Wide practice-level variation underscores the variability in diagnostic testing accuracy. Physicians should consider patient characteristics (e.g., sex, age, body mass index) when assessing carpal tunnel syndrome severity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.

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Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

December 1, 2022

Volume

150

Issue

6

Start / End Page

1287 / 1296

Location

United States

Related Subject Headings

  • Surgery
  • Severity of Illness Index
  • Retrospective Studies
  • Male
  • Humans
  • Hand
  • Carpal Tunnel Syndrome
  • Body Mass Index
  • 3203 Dentistry
  • 3202 Clinical sciences
 

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Billig, J. I., Kotsis, S. V., Ouyang, Z., Wang, L., Chung, K. C., Michigan Collaborative Hand Initiative for Quality in Surgery Collaborators, ., & members of the Michigan Collaborative Hand Initiative for Quality in Surgery are as follows: Study coordinators: Natalie Baxter (University of Michigan); Christian Cuevas (Indiana University Health); Karen Wasil and Brooke Marshall (University of Pittsburgh); Carter Gunn (OrthoCarolina Hand Center); Ike Fleming, Imran Yousaf, Kezia Alexander, Pragna Shetty, Lumanti Manandhar, Flossine Brown, and Alessandra Butanis (Curtis National Hand Center at MedStar Union Memorial Hospital); Alexander Dawes (Emory Orthopaedics, Sports & Spine); Raechel Argento (University of Rochester); Rachel Bordelon (Wake Forest Baptist Health); and Taylor Trentadue (Mayo Clinic). Study collaborators: Joshua Adkinson, M.D., John Fowler, M.D., R. Glenn Gaston, M.D., Aviram Giladi, M.D., M.S., Michael Gottschalk, M.D., Warren Hammert, D.D.S., M.D., Ryan Katz, M.D., Zhongyu John Li, M.D., Ph.D., Marco Rizzo, M.D., and Eric Wagner, M.D., M.S., . (2022). A Quality Collaborative Study of the Concordance of Electrodiagnostic Scores and Clinical Severity in Carpal Tunnel Syndrome. Plast Reconstr Surg, 150(6), 1287–1296. https://doi.org/10.1097/PRS.0000000000009675
Billig, Jessica I., Sandra V. Kotsis, Zhongzhe Ouyang, Lu Wang, Kevin C. Chung, Kevin C. Michigan Collaborative Hand Initiative for Quality in Surgery Collaborators, and Kevin C. members of the Michigan Collaborative Hand Initiative for Quality in Surgery are as follows: Study coordinators: Natalie Baxter (University of Michigan); Christian Cuevas (Indiana University Health); Karen Wasil and Brooke Marshall (University of Pittsburgh); Carter Gunn (OrthoCarolina Hand Center); Ike Fleming, Imran Yousaf, Kezia Alexander, Pragna Shetty, Lumanti Manandhar, Flossine Brown, and Alessandra Butanis (Curtis National Hand Center at MedStar Union Memorial Hospital); Alexander Dawes (Emory Orthopaedics, Sports & Spine); Raechel Argento (University of Rochester); Rachel Bordelon (Wake Forest Baptist Health); and Taylor Trentadue (Mayo Clinic). Study collaborators: Joshua Adkinson, M.D., John Fowler, M.D., R. Glenn Gaston, M.D., Aviram Giladi, M.D., M.S., Michael Gottschalk, M.D., Warren Hammert, D.D.S., M.D., Ryan Katz, M.D., Zhongyu John Li, M.D., Ph.D., Marco Rizzo, M.D., and Eric Wagner, M.D., M.S. “A Quality Collaborative Study of the Concordance of Electrodiagnostic Scores and Clinical Severity in Carpal Tunnel Syndrome.Plast Reconstr Surg 150, no. 6 (December 1, 2022): 1287–96. https://doi.org/10.1097/PRS.0000000000009675.
Billig JI, Kotsis SV, Ouyang Z, Wang L, Chung KC, Michigan Collaborative Hand Initiative for Quality in Surgery Collaborators, et al. A Quality Collaborative Study of the Concordance of Electrodiagnostic Scores and Clinical Severity in Carpal Tunnel Syndrome. Plast Reconstr Surg. 2022 Dec 1;150(6):1287–96.
Billig, Jessica I., et al. “A Quality Collaborative Study of the Concordance of Electrodiagnostic Scores and Clinical Severity in Carpal Tunnel Syndrome.Plast Reconstr Surg, vol. 150, no. 6, Dec. 2022, pp. 1287–96. Pubmed, doi:10.1097/PRS.0000000000009675.
Billig JI, Kotsis SV, Ouyang Z, Wang L, Chung KC, Michigan Collaborative Hand Initiative for Quality in Surgery Collaborators, members of the Michigan Collaborative Hand Initiative for Quality in Surgery are as follows: Study coordinators: Natalie Baxter (University of Michigan); Christian Cuevas (Indiana University Health); Karen Wasil and Brooke Marshall (University of Pittsburgh); Carter Gunn (OrthoCarolina Hand Center); Ike Fleming, Imran Yousaf, Kezia Alexander, Pragna Shetty, Lumanti Manandhar, Flossine Brown, and Alessandra Butanis (Curtis National Hand Center at MedStar Union Memorial Hospital); Alexander Dawes (Emory Orthopaedics, Sports & Spine); Raechel Argento (University of Rochester); Rachel Bordelon (Wake Forest Baptist Health); and Taylor Trentadue (Mayo Clinic). Study collaborators: Joshua Adkinson, M.D., John Fowler, M.D., R. Glenn Gaston, M.D., Aviram Giladi, M.D., M.S., Michael Gottschalk, M.D., Warren Hammert, D.D.S., M.D., Ryan Katz, M.D., Zhongyu John Li, M.D., Ph.D., Marco Rizzo, M.D., and Eric Wagner, M.D., M.S. A Quality Collaborative Study of the Concordance of Electrodiagnostic Scores and Clinical Severity in Carpal Tunnel Syndrome. Plast Reconstr Surg. 2022 Dec 1;150(6):1287–1296.

Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

December 1, 2022

Volume

150

Issue

6

Start / End Page

1287 / 1296

Location

United States

Related Subject Headings

  • Surgery
  • Severity of Illness Index
  • Retrospective Studies
  • Male
  • Humans
  • Hand
  • Carpal Tunnel Syndrome
  • Body Mass Index
  • 3203 Dentistry
  • 3202 Clinical sciences