Maximizing the Value of CTS-6: When Is Additional Testing Most and Least Likely to Change Diagnostic Probability?

IF 1.8 Q2 ORTHOPEDICS

HAND Pub Date : 2025-06-04 DOI:10.1177/15589447251343239

Christopher M Gibbs, John R Fowler

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引用次数: 0

Abstract

Background: Electrodiagnostic studies (EDS) have little diagnostic value when the probability of carpal tunnel syndrome (CTS) is high. Ultrasound (US) is useful for diagnosing CTS, but its effect on the diagnostic probability of CTS has not been well studied. The purpose of this study was to evaluate the change in probability of CTS following EDS and US. It was hypothesized that EDS and US would be of low diagnostic value for patients with a high CTS-6 (6-Item Carpal Tunnel Syndrome Questionnaire) score.

Methods: A cohort of patients with 295 extremities being assessed for compressive neuropathies of the upper extremity was prospectively evaluated using CTS-6, EDS, and US. The pretest probability of CTS was calculated using CTS-6. Bayesian analysis was used to calculate the posttest probability following EDS and US. Correlation, change in probability, and between-group differences were calculated.

Results: For all patients, there was a mean increased change in probability of CTS following EDS testing. The mean probability of CTS increased with pretest probability <.5; this effect was magnified in patients with diabetes. All patients with CTS-6 of 8 to 12 had a change in probability >10% following EDS and US, but with CTS-6 >17, a change >10% was seen in no patients following EDS and in 15% following US.

Conclusions: Adjunct testing is of greatest diagnostic value for patients with CTS-6 of 8 to 12. For patients with CTS-6 >17, adjunct testing is of little diagnostic value, but if additional testing is chosen, US may be of greater value than EDS.

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最大化CTS-6的价值：什么时候额外的测试最可能和最不可能改变诊断概率？

背景：当腕管综合征（carpal tunnel syndrome， CTS）发生概率较高时，电诊断研究（EDS）的诊断价值较低。超声（US）对CTS的诊断是有用的，但其对CTS诊断概率的影响尚未得到很好的研究。本研究的目的是评估EDS和US后CTS发生概率的变化。假设EDS和US对CTS-6 （6-Item腕管综合征问卷）评分较高的患者诊断价值较低。方法：采用CTS-6、EDS和US对295例上肢压缩性神经病变患者进行前瞻性评估。使用CTS-6计算CTS的预测概率。采用贝叶斯分析计算EDS和US后验概率。计算相关性、概率变化和组间差异。结果：对于所有患者，EDS检测后CTS发生概率的平均变化增加。在EDS和US后，CTS的平均概率增加了10%，但在CTS-6 - 17时，没有患者在EDS后变化了10%，在US后变化了15%。结论：辅助检查对CTS-6（8 ~ 12）患者的诊断价值最大。对于CTS-6患者，辅助检查几乎没有诊断价值，但如果选择额外的检查，US可能比EDS更有价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

HAND Medicine-Surgery

CiteScore

3.30

自引率

0.00%

发文量

209

期刊介绍： HAND is the official journal of the American Association for Hand Surgery and is a peer-reviewed journal featuring articles written by clinicians worldwide presenting current research and clinical work in the field of hand surgery. It features articles related to all aspects of hand and upper extremity surgery and the post operative care and rehabilitation of the hand.