IMPORTANCE: Distal symmetric polyneuropathy (DSP) is a prevalent condition that results in high costs from diagnostic testing. However, the role of neurologists and diagnostic tests in patient care is unknown. OBJECTIVE: To determine how often neurologists and diagnostic tests influence the diagnosis and management of DSP in a community setting. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study, we used a validated case-capture method (International Classification of Diseases, Ninth Revision screening technique with subsequent medical record abstraction) to identify all patients with a new DSP diagnosis treated by community neurologists in Nueces County, Texas, who met the Toronto Diabetic Neuropathy Expert Group consensus criteria for probable DSP. Using a structured data abstraction process, we recorded diagnostic test results, diagnoses rendered (before and after testing), and subsequent management from April 1, 2010, through March 31, 2011. MAIN OUTCOMES AND MEASURES: Changes in DSP cause and management after diagnostic testing by neurologists. RESULTS: We identified 458 patients with DSP followed up for a mean (SD) of 435.3 (44.1) days. Neurologists identified a cause of DSP in 291 patients (63.5%) before their diagnostic testing. Seventy-one patients (15.5%) had a new DSP cause discovered after testing by neurologists. The most common new diagnoses were prediabetes (28 [6.1%]), vitamin B12 deficiency (20 [4.4%]), diabetes mellitus (8 [1.7%]), and thyroid disease (8 [1.7%]). Management changes were common (289 [63.1%]) and usually related to neuropathic pain management (224 [48.9%]). A potential disease-modifying management change was made in 113 patients (24.7%), with the most common changes being diabetes management in 45 (9.8%), treatment with vitamins in 39 (8.5%), diet and exercise in 33 (7.2%), and adjustment of thyroid medications in 10 (2.2%). Electrodiagnostic testing and magnetic resonance imaging of the neuroaxis rarely led to management changes. CONCLUSIONS AND RELEVANCE: Neurologists diagnosed the cause of DSP in nearly two-thirds of patients before their diagnostic testing. Inexpensive blood tests for diabetes, thyroid dysfunction, and vitamin B12 deficiency allowed neurologists to identify a new cause of DSP in 71 patients (15.5%). In contrast, expensive electrodiagnostic tests and magnetic resonance imaging rarely changed patient care.
IMPORTANCE: Distal symmetric polyneuropathy (DSP) is a prevalent condition that results in high costs from diagnostic testing. However, the role of neurologists and diagnostic tests in patient care is unknown. OBJECTIVE: To determine how often neurologists and diagnostic tests influence the diagnosis and management of DSP in a community setting. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study, we used a validated case-capture method (International Classification of Diseases, Ninth Revision screening technique with subsequent medical record abstraction) to identify all patients with a new DSP diagnosis treated by community neurologists in Nueces County, Texas, who met the Toronto Diabetic Neuropathy Expert Group consensus criteria for probable DSP. Using a structured data abstraction process, we recorded diagnostic test results, diagnoses rendered (before and after testing), and subsequent management from April 1, 2010, through March 31, 2011. MAIN OUTCOMES AND MEASURES: Changes in DSP cause and management after diagnostic testing by neurologists. RESULTS: We identified 458 patients with DSP followed up for a mean (SD) of 435.3 (44.1) days. Neurologists identified a cause of DSP in 291 patients (63.5%) before their diagnostic testing. Seventy-one patients (15.5%) had a new DSP cause discovered after testing by neurologists. The most common new diagnoses were prediabetes (28 [6.1%]), vitamin B12 deficiency (20 [4.4%]), diabetes mellitus (8 [1.7%]), and thyroid disease (8 [1.7%]). Management changes were common (289 [63.1%]) and usually related to neuropathic pain management (224 [48.9%]). A potential disease-modifying management change was made in 113 patients (24.7%), with the most common changes being diabetes management in 45 (9.8%), treatment with vitamins in 39 (8.5%), diet and exercise in 33 (7.2%), and adjustment of thyroid medications in 10 (2.2%). Electrodiagnostic testing and magnetic resonance imaging of the neuroaxis rarely led to management changes. CONCLUSIONS AND RELEVANCE: Neurologists diagnosed the cause of DSP in nearly two-thirds of patients before their diagnostic testing. Inexpensive blood tests for diabetes, thyroid dysfunction, and vitamin B12 deficiency allowed neurologists to identify a new cause of DSP in 71 patients (15.5%). In contrast, expensive electrodiagnostic tests and magnetic resonance imaging rarely changed patient care.
Authors: J D England; G S Gronseth; G Franklin; G T Carter; L J Kinsella; J A Cohen; A K Asbury; K Szigeti; J R Lupski; N Latov; R A Lewis; P A Low; M A Fisher; D N Herrmann; J F Howard; G Lauria; R G Miller; M Polydefkis; A J Sumner Journal: Neurology Date: 2008-12-03 Impact factor: 9.910
Authors: G Savettieri; W A Rocca; G Salemi; F Meneghini; F Grigoletto; L Morgante; A Reggio; V Costa; M A Coraci; R Di Perri Journal: Neurology Date: 1993-06 Impact factor: 9.910
Authors: Edward W Gregg; Paul Sorlie; Ryne Paulose-Ram; Qiuping Gu; Mark S Eberhardt; Michael Wolz; Vicki Burt; Lester Curtin; Michael Engelgau; Linda Geiss Journal: Diabetes Care Date: 2004-07 Impact factor: 19.112
Authors: Brian C Callaghan; Rong Xia; Mousumi Banerjee; Nathalie de Rekeneire; Tamara B Harris; Anne B Newman; Suzanne Satterfield; Ann V Schwartz; Aaron I Vinik; Eva L Feldman; Elsa S Strotmeyer Journal: Diabetes Care Date: 2016-03-10 Impact factor: 19.112
Authors: Brian Callaghan; Kevin Kerber; Kenneth M Langa; Mousumi Banerjee; Ann Rodgers; Ryan McCammon; James Burke; Eva Feldman Journal: Neurology Date: 2015-05-27 Impact factor: 9.910
Authors: James F Burke; Eve A Kerr; Ryan J McCammon; Rob Holleman; Kenneth M Langa; Brian C Callaghan Journal: Neurology Date: 2016-07-08 Impact factor: 9.910