Impact of the electromiographic findings on choice of treatment and on outcome
Abstract
Background: Clinical electromyographers often do not get adequate feedback information about further clinical course in patients seen in electromyographic (EMG) clinics. The aim of the present study was to asses the impact of the EMG examination on patients’ final diagnosis, choice of treatment, and final clinical outcome.
Methods: Three years after EMG examination, performed by one of us, a short questionnaire was sent to 300 consecutive patients, and their referral physicians. We asked about symptoms at the time of EMG examination, final diagnosis, type of treatment, and current symptoms. Responses were analysed using methods of bivariate and multivariate statistical analysis.
Results: We received filled in questionnaires about 186 patients (39 % men). Of these 29 % patients were given diagnosis carpal tunnel syndrome, 19 % radiculopathy, 8 % other mononeuropathies, and 6 % polyneuropathy. No neurological diagnosis could be established during EMG consultation in remaining 39 % responding patients. On multiple linear regression analysis a significant association between EMG diagnosis and a final diagnosis was found. Furthermore, patients with pathological EMG findings had better final clinical outcome 3 years later; relationship persisted even after inclusion of treatment into multivariate model (exclusion of the effect). Patients with pathological EMG were also more often treated invasively, which further improved their final outcome. The most efficient treatment turned out to be surgery, followed by conservative management, and the outcome was the worst in patients that received no treatment.
Conclusions: The study demonstrated important impact of EMG findings on patients’ final diagnosis, treatment choice, and on final clinical outcome. EMG examination thus presents an important part in management of patients with suspected lesion of the peripheral neuromuscular system.
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