Each and every day, doctors diagnose patients with various diseases and disorders based on physical examinations, laboratory reports, and/or test results. But, what if the doctor doesn't complete all of the necessary testing? What if the doctor is a general practitioner who doesn't specialize in that particular area of medicine? As a patient, do you trust the initial diagnosis? Furthermore, would you want to ensure all appropriate testing was completed by a doctor properly trained in that specialty?
A recent article in Muscle & Nerve – "The Usefulness of Electrodiagnostic Studies in the Diagnosis and Management of Neuromuscular Disorders" – by Heather Lindstrom, MD, and Nigel L. Ashworth, MB.ChB., MSc, delves into this discussion. The purpose of their study was to "evaluate the usefulness of electrodiagnostic (EDX) studies in terms of the patient's diagnosis and subsequent management, and to identify patient groups where EDX is particularly useful."
There are two types of studies used in EDX medicine: nerve conduction studies and needle electromyography (EMG). As this Muscle & Nerve article states, "Electrodiagnostic (EDX) studies are commonly used in the evaluation of patients with neuromuscular disorders and can help confirm the clinical diagnosis, assess localization and severity of disease, and provide information to guide subsequent evaluation and treatment."
In order to determine the usefulness of EDX studies, the authors reviewed the records of 1,414 consecutive new patients referred to a single hospital's EDX laboratory during one calendar year (January 1 to December 31, 2015). EDX studies were performed on each patient and their records were analyzed to determine if the EDX studies changed the patient's diagnosis and/or management plan.
"In this extensive review, electrodiagnostic studies led to a change in diagnosis in more than half the patients in this study, and led to a change in management plan in more than 60%. In nearly half (46.5%), the studies confirmed the suspected diagnosis," said Zachary Simmons, MD, Editor-in-Chief, Muscle & Nerve. "It's important to note that the results in this study were obtained by properly trained and certified physicians in an accredited laboratory. Specifically, the electrodiagnostic physicians in this study were certified by the American Board of Electrodiagnostic Medicine (ABEM) or the Canadian Society of Clinical Neurophysiologists (CSCN), and the electrodiagnostic laboratory was accredited by the College of Physicians and Surgeons of Alberta."
Shirlyn A. Adkins, JD, Executive Director of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), says this article is an important read for physicians, particularly those who specialize in neuromuscular and electrodiagnostic medicine, as it can help them educate referral sources about the importance of sending patients in for EDX testing.
"Unfortunately, we do hear stories about patients undergoing surgery without ever having an EDX study. Or, we hear that the patient had an EDX study performed on them by an untrained physician or perhaps the patient only received the nerve conduction study portion of the test and never had a needle EMG. This Muscle & Nerve article illustrates the importance of ensuring full EDX testing is completed by a trained professional," noted Adkins. "Ideally, we recommend that patients be referred to physicians certified by ABEM or in an AANEM accredited laboratory."
Adkins continued by saying that the AANEM's mission and its members are dedicated to improving the quality of patient care and advancing the science of neuromuscular diseases and electrodiagnostic medicine.
"The results of this study are remarkable. It's hard to argue with the data – EDX studies changed the diagnosis for more than half the patients and the management plan changed for more than 60%. This goes to show that the work being done every day by the physicians and allied health professional members of the AANEM is having a major impact on patient care," Adkins said.
The overall conclusion by Heather Lindstrom, MD, and Nigel L. Ashworth, MB.ChB., MSc, the authors of the study, is that "a medical test that changes the diagnosis or management 50% or more of the time is highly effective." Dr. Simmons agrees. "This is important evidence that electrodiagnostic studies are of value in patient care."