Abstract
In order to improve the quality of service and limit costs of a local electromyographic service, the requests for electromyographic (EMG) examination issued by general practitioners and specialists were critically evaluated. The diagnoses suspected by referring doctors were compared with medical history and clinical data to analyze (1) the utility of EMG for the final diagnosis and (2) the concordance with that of the neurophysiologist and with the EMG results. In 1994 and 1995, there were 3482 patients referred to the EMG service. Only patients undergoing EMG for the first time (2706 subjects) were considered. In 76.6% of cases, the referring doctor had indicated the suspected diagnosis in the request. This diagnosis was compatible with medical history, symptoms and the results of neurological examination in 57.6% of cases. In 77.2%, the neurophysiologist considered the EMG useful in confirming the clinical diagnosis. The suspected diagnosis was confirmed by the clinical diagnosis of the neurophysiologist and by the EMG results in 54.2% and 45.4% of cases, respectively. When the request was issued by neurosurgeons, neurologists, orthopedists, rheumatologists and physiatrists, the suspected diagnosis was more accurate; as a consequence the EMG was more correctly oriented than when the request was issued by other specialists or by general practitioners. It is recommended that neurological examination be a prerequisite for EMG requests issued by general practitioners.
Sommario
È stato condotto uno studio di revisione critica dei sospetoi diagnostici che accompagnavano le richieste di esame elettromiografico, pervenute presso un ambulatorio territoriale di elettromiografia (EMG), allo scopo di migliorare la qualità del servizio offerto e contenere i costi di gestione. Sono state valutate, sulla base dell’obiettività clinica e dei dati anamnestici raccolti, la plausibilità del sospetto diagnostico che accompagnava le richieste redatte dai medici curanti e l’effettiva necessità di esecuzione dell’esame. È stata anche calcolata la concordanza tra il sospetto diagnostico del medico curante con la diagnosi finale formulata dal neurofisiologo prima dell’esecuzione dell’EMG, e con i risultati dell’EMG. Nel biennio 1994 e 1995 sono pervenuti 3482 pazienti. Lo studio è stato condotto sui pazienti che eseguivano l’esame per la prima volta (2706). Il sospetto diagnostico era indicato nel 76.6% dei casi ed era compatibile con la storia, i sintomi e l’obiettività neurologica del paziente nel 57.6%. Nel 77.7% dei casi la richiesta di EMG è stata ritenuta utile per la conferma diagnostica. La diagnosi clinica del neurofisiologo e i risultati EMG concordavano con il sospetto diagnostico indicato dal curante rispettivamente nel 54.2% e 45.4% dei casi. Le percentuali più alte di plausibilità del sospetto, di utilità della richiesta e di concordanza diagnostica si osservavano per le categorie dei neurochirurghi, neurologi, ortopedici, reumatologi e fisiatri rispetto ai medici di base e agli altri specialisti. Pertanto, gli Autori propongono che l’accesso diretto a un servizio di EMG del territorio sia consentito solo ai pazienti con richieste redatte da specialisti in neurologia, neurochirurgia, ortopedia, reumatologia e fisiatria. Per gli altri appare indispensabile eseguire prima una visita neurologica da parte di uno specialista.
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Mondelli, M., Giacchi, M. & Federico, A. Requests for electromyography from general practitioners and specialists: critical evaluation. Ital J Neuro Sci 19, 195–203 (1998). https://doi.org/10.1007/BF02427600
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DOI: https://doi.org/10.1007/BF02427600