title: Validation of the peroneal nerve test to diagnose critical illness polyneuropathy and myopathy in the intensive care unit: the multicentre Italian CRIMYNE-2 diagnostic accuracy study.
abstract: OBJECTIVE
  To evaluate the accuracy of the peroneal nerve test (PENT) in the diagnosis of critical illness polyneuropathy (CIP) and myopathy (CIM) in the intensive care unit (ICU). We hypothesised that abnormal reduction of peroneal compound muscle action potential (CMAP) amplitude predicts CIP/CIM diagnosed using a complete nerve conduction study and electromyography (NCS-EMG) as a reference diagnostic standard.
  
  
  METHODS
  prospective observational study.
  
  
  METHODS
  Nine Italian ICUs.
  
  
  METHODS
  One-hundred and twenty-one adult (≥18 years) neurologic (106) and non-neurologic (15) critically ill patients with an ICU stay of at least 3 days.
  
  
  METHODS
  None.
  
  
  RESULTS
  PATIENTS underwent PENT and NCS-EMG testing on the same day conducted by two independent clinicians who were blind to the results of the other test. Cases were considered as true negative if both NCS-EMG and PENT measurements were normal. Cases were considered as true positive if the PENT result was abnormal and NCS-EMG showed symmetric abnormal findings, independently from the specific diagnosis by NCS-EMG (CIP, CIM, or combined CIP and CIM). All data were centrally reviewed and diagnoses were evaluated for consistency with predefined electrophysiological diagnostic criteria for CIP/CIM. During the study period, 342 patients were evaluated, 124 (36.3%) were enrolled and 121 individuals with no protocol violation were studied. Sensitivity and specificity of PENT were 100% (95% CI 96.1-100.0) and 85.2% (95% CI 66.3-95.8). Of 23 patients with normal results, all presented normal values on both tests with no false negative results. Of 97 patients with abnormal results, 93 had abnormal values on both tests (true positive), whereas four with abnormal findings with PENT had only single peroneal nerve neuropathy at complete NCS-EMG (false positive).
  
  
  CONCLUSIONS
  PENT has 100% sensitivity and high specificity, and can be used as a screening test to diagnose CIP/CIM in the ICU.
authors.affiliation: Department of Anesthesia and Critical Care Medicine, University of Brescia at Spedali Civili, Brescia, 25123, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Latronico
authors.affiliation: Department of Clinical Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Ranica (BG), 24020, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Nattino
authors.affiliation: Department of Neuroscience, Section of Clinical Neurophysiology, Spedali Civili, Brescia, 25123, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Guarneri
authors.affiliation: Department of Anesthesia and Critical Care Medicine, University of Brescia at Spedali Civili, Brescia, 25123, Italy ; Department of Anesthesia and Critical Care Medicine, Section of Neuroanesthesia and Neurocritical Care, University of Brescia at Spedali Civili, Brescia, 25123, Italy.
authors.forename: Nazzareno
authors.initials: N
authors.lastname: Fagoni
authors.affiliation: Department of Neuroscience, Section of Clinical Neurophysiology, Azienda Ospedaliero-Universitaria Careggi, Firenze, 50134, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Amantini
authors.affiliation: Department of Clinical Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Ranica (BG), 24020, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Bertolini