Signs and symptoms versus nerve conduction studies to diagnose diabetic sensorimotor polyneuropathy: Cl vs. NPhys trial.
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.
Dyck
Peter J
PJ
Peripheral Neuropathy Research Laboratory, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA. dyck.peter@mayo.edu
Overland
Carol J
CJ
Low
Phillip A
PA
Litchy
William J
WJ
Davies
Jenny L
JL
Dyck
P James B
PJ
O'Brien
Peter C
PC
Albers
James W
JW
Andersen
Henning
H
Bolton
Charles F
CF
England
John D
JD
Klein
Christopher J
CJ
Llewelyn
J Gareth
JG
Mauermann
Michelle L
ML
Russell
James W
JW
Singer
Wolfgang
W
Smith
A Gordon
AG
Tesfaye
Solomon
S
Vella
Adrian
A
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