A Novel Insight Into the Challenges of Diagnosing Degenerative Cervical Myelopathy Using Web-Based Symptom Checkers

Abstract

BackgroundDegenerative cervical myelopathy (DCM) is a common debilitating condition resulting from degeneration of the cervical spine. While decompressive surgery can halt disease progression, existing spinal cord damage is often permanent, leaving patients with lifelong disability. Early surgery improves the likelihood of recovery, yet the average time from the onset of symptoms to correct diagnosis is over 2 years. The majority of delays occur initially, before and within primary care, mainly due to a lack of recognition. Symptom checkers are widely used by patients before medical consultation and can be useful for preliminary triage and diagnosis. Lack of recognition of DCM by symptom checkers may contribute to the delay in diagnosis.ObjectiveThe aims of this study were to investigate whether Web-based symptom checkers were able to recognize relevant symptoms of DCM, to characterize the DCM differential they returned , and to evaluate the diagnostic performance of recognized DCM symptoms.MethodsWe pooled classical DCM symptoms from leading review articles. These symptoms were entered into the algorithms used by the top 20 symptom checker websites (N=4; Google Search). The most widely cited symptom checker, WebMD, was used to characterize the differential diagnosis for DCM symptoms.ResultsA total of 31 classical DCM symptoms were identified, of which 45% (14/31) listed DCM as a differential and 10% (3/31) placed DCM in the top third of the differential. The mean differential rank for motor symptoms was significantly better than that for arthritic symptoms (P=.01) and the average differential rank for all symptoms (P=.048). The symptom checker WebMD performed best at recognizing DCM, placing the condition nearer to the top of the differential list (mean rank of 5.6) than either Healthline (rank of 12.9, P=.02) or Healthtools.AARP (rank of 15.5, P=.001). On WebMD, only one combination of symptoms resulted in DCM as the primary differential: neck, shoulder, and arm pain with hand weakness. Moreover, 151 differential diagnoses for DCM symptoms were recorded on WebMD. Multiple sclerosis and peripheral neuropathy were the most common differentials, shortlisted for 52% (16/31) and 32% (10/31) of the DCM symptoms, respectively.ConclusionsDCM symptoms are poorly identified by Web-based symptom checkers, which leads to a large differential of many other common conditions. While a diagnosis becomes more likely as the number of symptoms increases, this represents more advanced disease and will not support much-needed earlier diagnosis. Symptom checkers remain an attractive concept with potential. Further research is required to support their optimization.

Quantitative analysis of medical students’ and physicians’ knowledge of degenerative cervical myelopathy

“…Multiple sclerosis (MS), cauda equina syndrome (CES) and diabetes mellitus were selected as the three disease comparators and list of search terms compiled accordingly (table 2). 16–19 MS is a common differential for DCM,20 with overlapping signs and symptoms. While DCM is likely to be more prevalent in reality,1 currently their characterised epidemiology is comparable 21 22.…”

“…DCM patients were surveyed online and this confirmed that the diagnosis of DCM is frequently delayed 10. The question of whether this is due to lack of knowledge among health professionals and whether this was the consequence of a gap in medical education was formulated with the input of DCM sufferers at the First Cambridge Myelopathy day.…”

Current provision of myelopathy education in medical schools in the UK: protocol for a national medical student survey

“…In addition, an increasing number of less well-described symptoms such as dysaesthetic sensory symptoms, 6 chest tightness 20 and headache 21 are being reported. 22 Neurological examination findings include upper motor neuron signs in the upper and lower limbs: spasticity and hyperreflexia in addition to weakness. 1 14 …”

“…In addition, an increasing number of less well-described symptoms such as dysaesthetic sensory symptoms, 6 chest tightness 20 and headache 21 are being reported. 22 Neurological examination findings include upper motor neuron signs in the upper and lower limbs: spasticity and hyperreflexia in addition to weakness. 1 14 The latest international guidelines 23 recommend surgical decompression as the only evidence-based management 24 25 for patients with moderate to severe, or progressive DCM.…”

Outcomes of Degenerative Cervical Myelopathy From The Perspective of Persons Living With the Condition: Findings of a Semistructured Interview Process With Partnered Internet Survey

“…[3][4][5] These domains, for example, are all measured by the modified Japanese Orthopedic Association scale, the international standard on disease severity and reference for treatment decision making. 6 However, there are a number of reports of broader and prevalent disability, 7 including headaches, 8 movement disorders, 9 respiratory dysfunction, 10 and hypertension. 11 A screening tool developed in Japan identified chest pain as predictive of DCM.…”