Examining Complication Rates to Inform the Consent Process in Needle Electromyography: A Quality Improvement Project.

Abstract

Introduction/aims: Verbal informed consent prior to electrodiagnostic (EDx) studies, including nerve conduction study and needle electromyography (EMG), is considered the standard of care to counsel the patient of risks and benefits of the procedure. However, there is a paucity of population-based studies evaluating the actual occurrence of complications. We aim to improve the informed consent process for EMGs by accurately understanding rates of adverse events.

Methods: A rapid cycle quality improvement approach was used to assess complication rates for EMGs at a US Veterans Administration tertiary medical center. Potential complications were compared to actual complications following 24,718 EMG procedures performed over a 14-year period. The occurrence of serious complications in the month following EMG was queried from the electronic health record.

Results: About 35% of the patients used anticoagulants or antiplatelet agents, yet no cases of hematoma were recorded. Three reports of cellulitis occurred in patients on aspirin. No pneumothoraces were recorded. These findings were then used to update informed consent guidelines to more closely align with actual complication rates.

Discussion: This study underscores the safety of EMGs, even in the setting of anticoagulation use, and helps guide the informed consent process. Taking into consideration the findings of prior studies, caution must still be exercised when performing EMGs in muscles with a high risk of pneumothorax. Based on our findings, anticoagulants and antiplatelet agents do not appear to increase the risk of bleeding-related complications. Cellulitis in the three patients on aspirin was most likely due to medical comorbidities.