title: Awaji criteria improves the diagnostic sensitivity in amyotrophic lateral sclerosis: A systematic review using individual patient data.
abstract: OBJECTIVE
  To determine the utility of the Awaji criteria in diagnosing amyotrophic lateral sclerosis (ALS) and to propose a novel modification so as to enhance sensitivity based on results of individual patient data (IPD).
  
  
  METHODS
  Individual patient data were available from 8 studies comparing the diagnostic accuracy of Awaji and revised El Escorial (rEEC) criteria. The sensitivity of a novel updated Awaji criteria, incorporating a "probable-laboratory supported" category, was also tested.
  
  
  RESULTS
  Individual patient data were available from 1086 patients, consisting of 881 ALS and 205 patients with disorders mimicking ALS. Summary sensitivities based on random effects logistic regression modelling disclosed a higher sensitivity of the Awaji criteria (0.70, 95% confidence interval [CI] 0.51-0.83) and updated Awaji criteria (0.73, 95% CI 0.56-0.85) when compared to rEEC (0.58, 95% CI 0.48-0.68). Paired analysis revealed higher sensitivities of Awaji criteria in 4 studies, and of updated Awaji criteria in 7 studies, when compared to rEEC.
  
  
  CONCLUSIONS
  Individual patient data analysis established a higher sensitivity of Awaji criteria when compared to rEEC. The updated Awaji criteria enhanced the diagnostic sensitivity in limb-onset ALS.
  
  
  CONCLUSIONS
  The updated Awaji criteria should be considered in clinical practice and future therapeutic trials.
authors.affiliation: Western Clinical School, University of Sydney, Sydney, Australia.
authors.forename: Nimeshan
authors.initials: N
authors.lastname: Geevasinga
authors.affiliation: School of Public Health, University of Sydney, Sydney, Australia.
authors.forename: Clement T
authors.initials: CT
authors.lastname: Loy
authors.affiliation: Western Clinical School, University of Sydney, Sydney, Australia.
authors.forename: Parvathi
authors.initials: P
authors.lastname: Menon
authors.affiliation: Hospital of Santa Maria and Instituto de Medicina Molecular and Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
authors.forename: Mamede
authors.initials: M
authors.lastname: de Carvalho
authors.affiliation: Hospital of Santa Maria and Instituto de Medicina Molecular and Faculty of Medicine, University of Lisbon, Lisbon, Portugal; The Royal London Hospital and Queen Mary School of Medicine, University of London, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Swash
authors.affiliation: Neurology Department, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Maarten
authors.initials: M
authors.lastname: Schrooten
authors.affiliation: Neurology Department, University Hospitals Leuven, Leuven, Belgium; KU Leuven - University of Leuven, Department of Neurosciences, VIB - Vesalius Research Center, Experimental Neurology - Laboratory of Neurobiology, Leuven, Belgium.
authors.forename: Philip
authors.initials: P
authors.lastname: Van Damme
authors.affiliation: Department of Neurology, and Neurodegenerative Diseases Research Group, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Gawel
authors.affiliation: Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sonoo
authors.affiliation: Department of Neurology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
authors.forename: Mana
authors.initials: M
authors.lastname: Higashihara
authors.affiliation: Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Yu-Ichi
authors.initials: Y
authors.lastname: Noto
authors.affiliation: Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuwabara
authors.affiliation: Brain and Mind Center, University of Sydney, Sydney, Australia.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Kiernan
authors.affiliation: School of Public Health, University of Sydney, Sydney, Australia.
authors.forename: Petra
authors.initials: P
authors.lastname: Macaskill
authors.affiliation: Western Clinical School, University of Sydney, Sydney, Australia. Electronic address: s.vucic@neura.edu.au.
authors.forename: Steve
authors.initials: S
authors.lastname: Vucic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods* / Q000592:standards; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
keywords: Amyotrophic lateral sclerosis; Awaji criteria; El Escorial criteria; Meta-analysis