title: The effectiveness of post-offer pre-placement nerve conduction screening for carpal tunnel syndrome.
abstract: OBJECTIVE
  We evaluated post-offer pre-placement (POPP) nerve conduction studies (NCS) for carpal tunnel syndrome (CTS), testing diagnostic yield and cost-effectiveness.
  
  
  METHODS
  A total of 1027 newly hired workers underwent baseline NCS and were followed for an average of 3.7 years for diagnosed CTS. Measures of diagnostic yield included sensitivity, specificity, and positive predictive value (PPV). Cost-effectiveness of POPP screening was evaluated using a range of inputs.
  
  
  RESULTS
  Abnormal NCS was strongly associated with future CTS with univariate hazard ratios ranging from 2.95 to 11.25, depending on test parameters used. Nevertheless, PPV was poor, 6.4% to 18.5%. Cost-effectiveness of POPP varied with CTS case costs, screening costs, and NCS thresholds.
  
  
  CONCLUSIONS
  Although abnormal NCS at hire increases risk of future CTS, the PPV is low, and POPP screening is not cost-effective to employers in most scenarios tested.
authors.affiliation: From the Department of General Medical Sciences (Dr Dale, Dr Gardner, Ms Zeringue, and Dr Evanoff), Washington University School of Medicine; School of Public Health (Ms Zeringue), St Louis University, St Louis, Mo; and Department of Environmental and Health Sciences (Dr Werner and Dr Franzblau), University of Michigan School of Public Health, Ann Arbor.
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Dale
authors.forename: Bethany T
authors.initials: BT
authors.lastname: Gardner
authors.forename: Angelique
authors.initials: A
authors.lastname: Zeringue
authors.forename: Robert
authors.initials: R
authors.lastname: Werner
authors.forename: Alfred
authors.initials: A
authors.lastname: Franzblau
authors.forename: Bradley
authors.initials: B
authors.lastname: Evanoff
mesh_terms: D000328:Adult; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000503:physiopathology*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D009431:Neural Conduction; D016272:Occupational Health; D011237:Predictive Value of Tests; D011446:Prospective Studies
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