title: Signs and symptoms versus nerve conduction studies to diagnose diabetic sensorimotor polyneuropathy: Cl vs. NPhys trial.
abstract: The purpose was to test whether physicians can validly and reproducibly diagnose diabetic sensorimotor polyneuropathy (DSPN). Twelve physicians assessed 24 patients with diabetes mellitus (DM) on consecutive days (576 examinations) with physical features and voice disguised. Results were compared to gold standard 75% group diagnosis (dx) and a nerve conduction score (Sigma5 NC nds). Masking of patients was achieved. Reproducibility measured by the kappa coefficient and compared to Sigma5 NC nd varied considerably among physicians: median and ranges: signs 0.8 (0.32-1.0); symptoms 0.79 (0.36-1.0), and diagnoses 0.47 (0.33-0.84), both low and high scores indicating poor performance. There was substantial agreement between 75% group dx and confirmed NC abnormality (abn). As compared to Sigma5 NC, individual physicians' clinical dx was excessively variable and frequently inaccurate. Study physician dx from signs and symptoms were excessively variable, often overestimating DSPN. Specific approaches to improving clinical proficiency should be tested.
authors.affiliation: Peripheral Neuropathy Research Laboratory, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA. dyck.peter@mayo.edu
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Dyck
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Overland
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Low
authors.forename: William J
authors.initials: WJ
authors.lastname: Litchy
authors.forename: Jenny L
authors.initials: JL
authors.lastname: Davies
authors.forename: P James B
authors.initials: PJ
authors.lastname: Dyck
authors.forename: Peter C
authors.initials: PC
authors.lastname: O'Brien
authors.forename: James W
authors.initials: JW
authors.lastname: Albers
authors.forename: Henning
authors.initials: H
authors.lastname: Andersen
authors.forename: Charles F
authors.initials: CF
authors.lastname: Bolton
authors.forename: John D
authors.initials: JD
authors.lastname: England
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Klein
authors.forename: J Gareth
authors.initials: JG
authors.lastname: Llewelyn
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Mauermann
authors.forename: James W
authors.initials: JW
authors.lastname: Russell
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Singer
authors.forename: A Gordon
authors.initials: AG
authors.lastname: Smith
authors.forename: Solomon
authors.initials: S
authors.lastname: Tesfaye
authors.forename: Adrian
authors.initials: A
authors.lastname: Vella
mesh_terms: D000368:Aged; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000503:physiopathology; D004568:Electrodiagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D009460:Neurologic Examination; D011115:Polyneuropathies / Q000175:diagnosis* / Q000503:physiopathology; D012016:Reference Values; D015203:Reproducibility of Results