58 KB119 KB54 KB192920262003Podnar, Simonštevilka:4letnik:72str. 205-212ISSN:1318-0347COBISSID:16259289URN:URN:NBN:SI:doc-UDGO4N2GslSlovensko zdravniško društvoZdravniški vestnikBrachial PlexusBrahialni pletežCarpal Tunnel SyndromeContraindicationsDiagnosisElectromyographyelektrodiagnostikaElektromiografijaKriž, bolečinaLow Back PainMethodsNeuritisNeurologic ExaminationneurologyNevritisnevrologijaNevrološka preiskavaperiferno živčevjePeriferno živčevje, bolezniPeripheral Nervous System DiseasesPolyneuritisRadiculitisUtilizationZapestni prehod, sindromKritična analiza napotitev na elektrodiagnostično preiskavo perifernega živčevja| Critical analysis of referrals to electrodiagnostic examination of the peripheral nervous system|Background. Clinical neurophysiologists observe a large number of examinees referred to a electromyographic (EMG) laboratory without clinical symptoms or signs of the peripheral nervous system lesion. Such referrals do not improve management of patients, but only unnecessarily burden examinees and laboratorypersonnel. The aim of the present study was to check appropriatenessof referrals to electrodiagnostic examination, look for reasonsfor problems and suggest possible improvements. Methods. From the database of the Institute of Clinical Neurophysiology in Ljubljana all examinees evaluated by the author in a "general" EMG laboratory in the first 4months of 2002 were included. From data about examinees, referral doctors, referral diagnoses, clinical symptoms and signs and electrophysiological findings, predictive values for neurological referral diagnoses and electrodiagnostic abnormalities were calculated using descriptive and multivariate statistical analyses. Results. Three hundred examinees (42% men) were included. Neurological diagnosis was provided in 55% of referrals. Electrodiagnostic abnormalities were found in 45% of examinees (carpal tunnel syndrome 50% radiculopathy 25%, other mononeuropathies 15%, polineuropathy 9%). In 9% of examinees only clinical, and in 47% neither clinical nor electrodiagnostic abnormalities were demonstrated. Using a multivariate analysis positive effect of referral with neurological diagnosis, of paraesthesiae and findings of weakness and sensory loss, and negative effect of pain and referral diagnosis cervicobrachialgia or lumboischialgia on pathological electrodiagnostic findings were found. Isolated pain and paraesthesiae (with carpal tunnel syndrome excluded) were particularly poor predictors of abnormal electrodiagnostic findings (9% and 16%, respectively). With exception of 20 patients with carpal tunnel syndrome, none with normal clinical neurological examination had abnormal electrodiagnostic findingsIzhodišča. Pri delu v elektromiografski (EMG) ambulanti klinični nevrofiziologi opažamo številne napotitve preiskovancev brez okvare perifernega živčevja. Tovrstne napotitve ne izboljšujejo obravnave bolnikov, ampak preiskovance in zdravstveno osebje po nepotrebnem obremenjujejo. Namen naše raziskave je bil na reprezentativnem vzorcu preveriti ustreznost napotitev na elektrodiagnostične preiskave, poiskati vzroke za morebitne slabosti in predlagati možne rešitve. Metode. V raziskavi smo iz arhiva Inštituta za klinično nevrofiziologijo v Ljubljani izbrali vse preiskovance, ki jih je avtor pregledal v "splošni" EMG ambulanti v prvi tretjini leta 2002.S pomočjo opisne in multivariantne statistike smo iz zbranih podatkov izračunali napovedne dejavnike za oblikovanje nevrološke napotne diagnoze in za patološke izvide elektrodiagnostičnih preiskav. Rezultati. V raziskavo smo vključili 300 preiskovancev, 42% moških. Z nevrološko diagnozo je bilo napotenih 55% preiskovancev. Okvaro perifernega živčevja smo elektrodiagnostično potrdili pri 45% preiskovancev (sindrom zapestnega prehoda50%, radikulopatijo 25%, ostale mononevropatije 15%, polinevropatijo 9%). Pri 9% preiskovancev smo našli le klinične, pri 47% pa ne kliničnih in neelektrofizioloških znakov okvare. Z multivariantno analizo smo našli pozitiven vpliv napotitve z nevrološko diagnozo, navedbe mravljinčenja in najdbe šibkosti ali motene senzibilitete ter negativen vpliv navedbe bolečin in napotne diagnoze cervikobrahialgija ali lumboishialgija na patološki elektrodiagnostični izvid. Napovedna vrednost izoliranih bolečin in ob izključitvi sindroma zapestnega prehoda tudi mravljinčenja je bila nizka (9% in 16% patoloških preiskav). Z izjemo 20 preiskovancev s sindromom zapestnega prehoda pri nobenem od preiskovancev z normalnim kliničnim nevrološkim izvidomnismo našli elektrodiagnostične abnormnostiTEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo