title: Diagnostic yield of the palmomental reflex in patients with suspected frontal lesion.
abstract: BACKGROUND
  The purpose of this study was to determine the diagnostic value of the palmomental reflex in order to identify frontal lesions in neurological outpatients.
  
  
  METHODS
  Two hundred twenty-six neurological patients with suspected intracranial lesion with an indication for magnetic resonance imaging (MRI) were included. All patients underwent the same MRI protocol. The reflex was elicited by trained and standardized nurses, and was evaluated by two neurologists. The evaluation was blind and independent. The test's accuracy was calculated. The Kappa coefficient was used to calculate the interobserver and intra-observer reliability.
  
  
  RESULTS
  The interobserver reliability between neurologists was 0.53 with 93% of agreement (p<0.001). The diagnostic accuracy measures were as follow: sensitivity of 19%, specificity of 93%, positive predictive value of 30%, negative predictive value of 88%, positive likelihood ratio of 2.7 and negative likelihood ratio of 0.87. The area under the curve was 0.56.
  
  
  CONCLUSIONS
  The palmomental reflex is associated with frontal structural lesions but the sensitivity is low, indicating a high percentage of frontal lesions with a negative reflex. When the test is used on its own, it is insufficient to detect frontal damage.
authors.affiliation: Neurology Section, Hospital Pablo Tobón Uribe, Medellín, Colombia; Instituto de Alta Tecnología Médica, Medellín, Colombia; University of Antioquia, Medellín, Colombia; University of Saskatchewan, Royal University Hospital, Saskatoon, Canada. Electronic address: lady.ladino@gmail.com.
authors.forename: Lady D
authors.initials: LD
authors.lastname: Ladino
authors.affiliation: University of Antioquia, Medellín, Colombia.
authors.forename: Sandra
authors.initials: S
authors.lastname: Isaza
authors.affiliation: Instituto de Alta Tecnología Médica, Medellín, Colombia.
authors.forename: Jorge
authors.initials: J
authors.lastname: Delgado
authors.affiliation: Instituto de Alta Tecnología Médica, Medellín, Colombia.
authors.forename: Simon
authors.initials: S
authors.lastname: Rascovsky
authors.affiliation: University of Antioquia, Medellín, Colombia.
authors.forename: Carlos
authors.initials: C
authors.lastname: Uribe
authors.affiliation: University of Antioquia, Medellín, Colombia.
authors.forename: Santiago
authors.initials: S
authors.lastname: Acebedo
authors.affiliation: University of Antioquia, Medellín, Colombia.
authors.forename: William
authors.initials: W
authors.lastname: Cornejo
authors.affiliation: University of Saskatchewan, Royal University Hospital, Saskatoon, Canada.
authors.forename: Lizbeth
authors.initials: L
authors.lastname: Hernandez-Ronquillo
authors.affiliation: University of Saskatchewan, Royal University Hospital, Saskatoon, Canada.
authors.forename: Jose F
authors.initials: JF
authors.lastname: Tellez-Zenteno
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000175:diagnosis* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D005625:Frontal Lobe / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008663:Metacarpus / Q000294:innervation*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology*; D010812:Physical Stimulation; D012018:Reflex / Q000502:physiology*; D013216:Reflex, Startle / Q000502:physiology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult
keywords: Diagnostic test; Marinesco–Radovici; Neurological signs; Physical examination; Primitive reflex; Semiology