| Abstract | Objectives: This study aimed to assess the character of referrals that justify electrodiagnostic
testing in a sample of patients from Dalmatia County, Croatia, and to identify the specialty of
referring physicians.
Methods: This descriptive cross-sectional study involved 100 patients from the outpatient
clinic of the Neurology department at the University Hospital Split from July 2020. Patients'
initials, gender, date of birth, diagnosis in form of ICD-10 criteria numbers, and data on
whether the patient got referred by a specialist and if so, by which specialists were collected.
Indications justifying an EMNG examination were based on American guidelines by the
AANEM, health insurance companies such as First Coast Service Options, Inc., and centers
for Medicare and Medicaid services; an official American government website. The computer
software MedCalc for Microsoft Windows was used to conduct data analysis.
Results: Participants’ ages varied from 21 to 85 years and the median age of the study
population was 59.0 years (52.5-68.0). The gender distribution showed 63 females and 37
males. There were 45 (45%) referrals to an EMNG by a general practitioner and 55 (55%)
referrals by a specialist. Moreover, there were 83 (83%) referrals to an EMNG with an
indication for the patient diagnosis while there were 17 (17%) without an indication for the
diagnosis. However, there was no statistically significant difference between the GP and the
specialist’s referral to an EMNG without an indication for the patient diagnosis (5 (29.4%) vs
12 (71.6%), p = 0.249). Most specialist referrals were made by a neurologist 35 (63.3%), while
the least were made by a rheumatologist 1 (1.8%). There was a statistically significant
difference (p = 0.032) between different specialist referrals to an EMNG depending on the
indication for the patient diagnosis. The most frequent diagnosis with an indication justifying
an EMNG examination was lumbosacral syndrome with a rate of 31 (37.3%) while the least
frequent was myasthenia gravis with a rate of 1 (1.2%). On the other hand, the most frequent
diagnosis without an indication for an EMNG was arthropathy/arthralgia 9 (52.9%), while the
least frequent were atrial fibrillation 1 (5.9%) and cutaneous paresthesia 1 (5.9%).
Conclusion: This study concludes that most patients have a true indication justifying an
EMNG examination with the most common diagnosis being lumbosacral syndrome.
Meanwhile, the most common diagnosis that did not justify an EMNG examination was
Arthropathy or Arthralgia. Moreover, most specialist referrals were made by a neurologist
establishing the good referral practice seen in this study. |
| Abstract (croatian) | Ciljevi: Cilj ovog istraživanja bio je procijeniti karakter uputnica koje opravdavaju
elektrodijagnostičko testiranje na uzorku pacijenata s područja Dalmatinske županije,
Hrvatska, te identificirati specijalnost liječnika koji su uputili.
Metode: Ova deskriptivna studija presjeka obuhvatila je 100 pacijenata iz ambulante
Neurologije KBC- u Split od srpnja 2020. Inicijali pacijenata, spol, datum rođenja, dijagnoza
u obliku brojeva kriterija ICD-10 i podaci o tome je li pacijenta uputio specijalist i ako jest,
koji je specijalist uputio. Indikacije koje opravdavaju pregled EMNG-a temeljile su se na
američkim smjernicama od strane AANEM-a, društava za zdravstveno osiguranje kao što je
First Coast Service Options, Inc. i centara za medicare i medicaid usluge; službena web stranica
američke vlade. Za analizu podataka korišten je računalni softver MedCalc za Microsoft
Windows.
Rezultati: Dob sudionika varirala je od 21 do 85 godina, a srednja dob ispitivane populacije
bila je 59,0 godina (52,5-68,0). Spolna distribucija pokazala je 63 žene i 37 muškaraca. Na
EMNG je bilo 45 (45%) uputnica liječnika opće prakse i 55 (55%) uputnica specijalista.
Štoviše, bilo je 83 (83%) upućenih na EMNG s indikacijom za dijagnozu bolesnika, dok ih je
17 (17%) bez indikacije za dijagnozu. Međutim, nije bilo statistički značajne razlike između
upućivanja liječnika opće prakse i specijaliste na EMNG bez indikacije za dijagnozu bolesnika
(5 (29,4%) prema 12 (71,6%), p = 0,249). Najviše specijalističkih uputnica uputio je neurolog
35 (63,3%), a najmanje reumatolog 1 (1,8%). Utvrđena je statistički značajna razlika (p=0,032)
između različitih specijalističkih uputa na EMNG ovisno o indikaciji za dijagnozu bolesnika.
Najčešća dijagnoza s indikacijom koja opravdava EMNG pretragu bila je lumbosakralni
sindrom sa stopom od 31 (37,3%), a najrjeđa miastenija gravis sa stopom 1 (1,2%). S druge
strane, najčešća dijagnoza bez indikacija za EMNG bila je artropatija/artralgija 9 (52,9%), a
najrjeđe fibrilacija atrija 1 (5,9%) i kožna parestezija 1 (5,9%)
Zaključci: Ovo istraživanje zaključuje da većina pacijenata ima pravu indikaciju koja
opravdava EMNG pretragu, a najčešća dijagnoza je lumbosakralni sindrom. U međuvremenu,
najčešća dijagnoza koja nije opravdavala EMNG pretragu bila je artropatija ili artralgija.
Štoviše, većinu specijalističkih uputa dao je neurolog, čime se uspostavlja dobra praksa
upućivanja viđena u ovoj studiji. |
