Surgical Timing for Carpal Tunnel Syndrome: A Comparison of Health Care Delivery in the Veterans Administration and Private Sector

Billig, Jessica I.; Lu, Yuting; Hayward, Rodney A.; Sears, Erika D.

doi:10.1016/j.jhsa.2021.02.022

The Journal of Hand Surgery

2021

DOI: 10.1016/j.jhsa.2021.02.022

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Surgical Timing for Carpal Tunnel Syndrome: A Comparison of Health Care Delivery in the Veterans Administration and Private Sector

Jessica I. Billig

Yuting Lu

Rodney A. Hayward

et al.

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Cited by 4 publications

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“…7,8 Along with the added discomfort and cost of this test, the use of electrodiagnostic studies is associated with delays in wait time to see a hand surgeon and treatment. [8][9][10][11] If used as a confirmatory test, electrodiagnostic studies should have a high specificity to decrease the likelihood of false-positive results; however, it has been shown to have the lowest specificity compared to other tests. 12 In addition, there are mixed reviews regarding a correlation between electrodiagnostic findings and self-reported symptoms and function.…”

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confidence: 99%

A Quality Collaborative Study of the Concordance of Electrodiagnostic Scores and Clinical Severity in Carpal Tunnel Syndrome

Billig

Kotsis

Ouyang

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Electrodiagnostic studies are commonly used to diagnose carpal tunnel syndrome. However, these examinations are prone to false-positive and false-negative values. The authors evaluated the agreement of electrodiagnostic study severity, clinical assessment scores, and probability of carpal tunnel syndrome [Six-Item Carpal Tunnel Syndrome Evaluation Tool (CTS-6) scores. Methods: This was a retrospective cohort study of 609 patients with carpal tunnel syndrome (941 hands). Data were collected from nine hand surgery practices in the Michigan Collaborative Hand Initiative for Quality in Surgery. Goodman and Kruskal gamma statistics (γ) measured the agreement between electrodiagnostic studies and clinical assessment scores and between electrodiagnostic studies and CTS-6 scores. The authors performed cumulative logistic regression with mixed effects to evaluate the association among electrodiagnostic study severity, clinical assessments, and patient characteristics. Results: The concordance between electrodiagnostic study severity and CTS-6 scores was γ = 0.31 (95 percent CI, 0.21 to 0.40), with an accuracy of 43 percent. The concordance between electrodiagnostic study severity and clinical assessment scores was γ = 0.66 (95 percent CI, 0.58 to 0.74), with an accuracy of 58 percent. Wide site-level variation in the γ coefficient between electrodiagnostic studies and clinical assessment scores and between electrodiagnostic studies and CTS-6 was seen. Male sex, increasing age, and increasing body mass index were significantly associated with increased odds of electrodiagnostic study severity. Conclusions: Wide practice-level variation underscores the variability in diagnostic testing accuracy. Physicians should consider patient characteristics (e.g., sex, age, body mass index) when assessing carpal tunnel syndrome severity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.

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mentioning

confidence: 99%

A Quality Collaborative Study of the Concordance of Electrodiagnostic Scores and Clinical Severity in Carpal Tunnel Syndrome

Billig

Kotsis

Ouyang

et al. 2022

Plastic &Amp; Reconstructive Surgery

Self Cite

View full text Add to dashboard Cite

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Appointment wait times for surgical care in the Veterans Health Administration and Community Care Program

Friedl,

Jella,

Cwalina

et al. 2023

Surgery

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Carpal Tunnel Syndrome Electrodiagnostic Severity is Not Associated with PROMIS Upper Extremity, PROMIS Pain Interference and PROMIS Pain Intensity

ZHANG,

EARP,

BLAZAR

2024

J Hand Surg Asian-Pac Vol

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Background: The primary objective of this study was to determine the association between preoperative electrodiagnostic study (EDS) parameters and Patient-Reported Outcomes Measurement Information System (PROMIS) instruments in patients with EDS-confirmed carpal tunnel syndrome (CTS). Methods: A retrospective study of 45 patients with EDS-confirmed CTS was conducted. Patients completed the PROMIS Upper Extremity, PROMIS Pain Interference and PROMIS Pain Intensity. Explanatory variables included EDS disease severity (mild, moderate and severe), sensory peak latency, sensory amplitude, motor latency, motor amplitude, the presence of nonrecordable sensory latency and the presence of nonrecordable sensory amplitude. Explanatory variables also included patient-related factors, such as age, sex and diabetes mellitus. Associations between variables were assessed using simple linear regression, analysis of variance (ANOVA) and Student’s t-test. Results: In our cohort, the EDS severity was mild in 38%, moderate in 42% and severe in 20% of patients. The mean PROMIS Upper Extremity score was 44.4, the mean PROMIS Pain Interference score was 53.5 and the mean PROMIS Pain Intensity score was 49.9. Bivariate analysis demonstrated no association between EDS severity overall or any EDS parameter individually and PROMIS Upper Extremity, PROMIS Pain Interference and PROMIS Pain Intensity. Diabetes mellitus was associated with poorer PROMIS Upper Extremity scores. Conclusions: EDS severity is not associated with PROMIS Upper Extremity, PROMIS Pain Interference and PROMIS Pain Intensity. Carpal tunnel release is commonly indicated for pain and dysfunction, but validated measures of pain and dysfunction do not correlate with EDS severity. Level of Evidence: Level III (Diagnostic)

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Surgical Timing for Carpal Tunnel Syndrome: A Comparison of Health Care Delivery in the Veterans Administration and Private Sector

Cited by 4 publications

References 14 publications

A Quality Collaborative Study of the Concordance of Electrodiagnostic Scores and Clinical Severity in Carpal Tunnel Syndrome

A Quality Collaborative Study of the Concordance of Electrodiagnostic Scores and Clinical Severity in Carpal Tunnel Syndrome

Appointment wait times for surgical care in the Veterans Health Administration and Community Care Program

Carpal Tunnel Syndrome Electrodiagnostic Severity is Not Associated with PROMIS Upper Extremity, PROMIS Pain Interference and PROMIS Pain Intensity

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