Clinical outcomes of electrodiagnostic testing conducted in primary care.
J Am Board Fam Med. 2010 Sep-Oct;23(5):584-90
Authors: Shepherd MM
BACKGROUND: Focal and generalized neuropathies, such as carpal tunnel syndrome and diabetic peripheral neuropathy, have high prevalence among the US population. Primary care physicians are increasingly using computerized electrodiagnostic (EDX) testing to evaluate these patients. The impact of this diagnostic modality on physician diagnostic reasoning and patient management has not been directly studied. METHODS: Consecutive computerized EDX tests conducted in a primary care clinic were prospectively evaluated using a diagnostic before-and-after study design. The pretest diagnosis and patient management plan were noted before EDX testing. Five clinical outcomes were assessed after the test: (1) test abnormality, (2) confirmation of pretest diagnosis, (3) change in pretest diagnosis, (4) expansion of pretest diagnosis, and (5) change to patient management plan. RESULTS: One hundred computerized EDX tests were performed among 85 patients. A total of 88 tests were abnormal. The pretest diagnosis was confirmed in 59 tests. The pretest diagnosis was changed by 14 tests and it was expanded by 18 tests. The computerized EDX tests triggered a change in clinical management in 30 cases, with referral to orthopedic surgery and metabolic workup for polyneuropathy as the most common changes. CONCLUSIONS: Computerized EDX testing was clinically valuable in patients with moderate to high pretest probability of common neuropathies such as carpal tunnel syndrome and diabetic polyneuropathy. In approximately one third of cases, the test led to a change in clinical management.
20823352
– Clinical outcomes of electrodiagnostic testing conducted in primary care.
Clinical outcomes of electrodiagnostic testing conducted in primary care.
J Am Board Fam Med. 2010 Sep-Oct;23(5):584-90
Authors: Shepherd MM
BACKGROUND: Focal and generalized neuropathies, such as carpal tunnel syndrome and diabetic peripheral neuropathy, have high prevalence among the US population. Primary care physicians are increasingly using computerized electrodiagnostic (EDX) testing to evaluate these patients. The impact of this diagnostic modality on physician diagnostic reasoning and patient management has not been directly studied. METHODS: Consecutive computerized EDX tests conducted in a primary care clinic were prospectively evaluated using a diagnostic before-and-after study design. The pretest diagnosis and patient management plan were noted before EDX testing. Five clinical outcomes were assessed after the test: (1) test abnormality, (2) confirmation of pretest diagnosis, (3) change in pretest diagnosis, (4) expansion of pretest diagnosis, and (5) change to patient management plan. RESULTS: One hundred computerized EDX tests were performed among 85 patients. A total of 88 tests were abnormal. The pretest diagnosis was confirmed in 59 tests. The pretest diagnosis was changed by 14 tests and it was expanded by 18 tests. The computerized EDX tests triggered a change in clinical management in 30 cases, with referral to orthopedic surgery and metabolic workup for polyneuropathy as the most common changes. CONCLUSIONS: Computerized EDX testing was clinically valuable in patients with moderate to high pretest probability of common neuropathies such as carpal tunnel syndrome and diabetic polyneuropathy. In approximately one third of cases, the test led to a change in clinical management.
20823352
– Clinical outcomes of electrodiagnostic testing conducted in primary care.
Nasolaryngoscopy in a family medicine clinic: indications, findings, and economics.
J Am Board Fam Med. 2010 Sep-Oct;23(5):591-7
Authors: Wilkins T, Gillies RA, Getz A, Zimmerman D, Kang L
BACKGROUND: Nasopharyngeal complaints are common among patients who present to primary care. Patients with these complaints are often referred for nasolaryngoscopy evaluation to exclude serious conditions such as laryngeal cancer. METHODS: This study is a retrospective case series in which 276 charts of adult outpatients who were referred for nasolaryngoscopy were reviewed. We examined patient demographics, procedure indications and findings, complications, and changes in clinical management. RESULTS: Nasolaryngoscopy was completed in 273 (98.9%) patients (mean age, 51.3 +/- 14.6 years; 71.4% were women). The most common indications for nasolaryngoscopy were hoarseness (51.3%), globus sensation (32.0%), and chronic cough (17.1%); the most common findings included laryngopharyngeal reflux (42.5%), chronic rhinitis (32.2%), and vocal cord lesions (13.2%). Three patients (1.1%) were diagnosed with laryngeal cancer and this diagnosis was significantly associated with a history of smoking (P = .03). No major complications occurred. CONCLUSIONS: We found that nasolaryngoscopy was a safe procedure in the primary care setting, and no major complications occurred in our series. Patients who have ever smoked and complain of hoarseness are at higher risk for laryngeal cancer. An alarming 1% of patients in our series were diagnosed with laryngeal cancer. This is the first study to define the rates of laryngopharyngeal reflux, vocal cord lesions, and laryngeal cancer among primary care patients.
20823353
– Nasolaryngoscopy in a family medicine clinic: indications, findings, and economics.
