title: A calibrated paper clip is a reliable measure of two-point discrimination.
abstract: OBJECTIVE
  The primary objective of this study was to compare two different instruments for assessing digital nerve function; a secondary aim was to determine interobserver agreement among emergency physicians by using static two-point testing of digital nerve function.
  
  
  METHODS
  This was a prospective, blinded, observational study of static two-point discrimination involving healthy volunteers aged 18-59 years. The authors compared two instruments (paper clip set or Disk-Criminator) to assess two-point discrimination of the index and long fingers of the dominant hand. For each subject, the initial investigator and initial testing instrument were randomized. Two-point testing was conducted at 4, 5, and 6 mm by using six randomly selected stimuli (1 or 2 points) for each distal phalanx tested. The study was designed to detect a 25% difference in mean two-point distance with a power of 80%.
  
  
  RESULTS
  Seventy-five subjects were entered into the study, of which two were excluded. Interinstrument agreement for a given investigator ranged from 77% to 84% for absolute agreement and 98% to 100% within 2 mm. Weighted kappa values for interobserver differences of 2 mm or less was 0.79 to 1.00. There was no statistically significant difference between instruments.
  
  
  CONCLUSIONS
  Using a clinically relevant threshold of 2 mm, the authors found that a properly calibrated set of paper clips performed as well as the Disk-Criminator.
authors.affiliation: Department of Emergency Medicine, University of Minnesota Regions Hospital, St. Paul, MN, USA. jt@emqube.org
authors.forename: John T
authors.initials: JT
authors.lastname: Finnell
authors.forename: Robert
authors.initials: R
authors.lastname: Knopp
authors.forename: Phelps
authors.initials: P
authors.lastname: Johnson
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Holland
authors.forename: Warren
authors.initials: W
authors.lastname: Schubert
mesh_terms: D000293:Adolescent; D000328:Adult; D004056:Differential Threshold; D004635:Emergency Medicine / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006225:Hand / Q000294:innervation* / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014110:Touch / Q000502:physiology*