Kirsten Pugdahl1, Jean-Philippe Camdessanché2, Bülent Cengiz3, Mamede de Carvalho4, Rocco Liguori5, Céline Rossatto2, Miguel Oliveira Santos4, Veria Vacchiano5, Birger Johnsen6. 1. Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark. 2. Department of Neurology, Saint-Etienne University Hospital, Saint-Etienne, France. 3. Department of Neurology, Gazi University Faculty of Medicine, Beşevler, 06500 Ankara, Turkey. 4. Institute of Physiology-Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Department of Neurosciences, Hospital de Santa Maria-CHULN, Lisbon, Portugal. 5. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy. 6. Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: birgjohn@rm.dk.
Abstract
OBJECTIVE: This study evaluates diagnostic accuracy of the proposed 'Gold Coast' (GC) diagnostic criteria for amyotrophic lateral sclerosis (ALS). METHODS: Five European centres retrospectively sampled consecutive patients referred for electromyography on suspicion of ALS. Patients were classified according to the GC criteria, the revised El Escorial (rEE) criteria and the Awaji (AW) criteria without and with the 'Possible' category (+ Poss). Reference standard was ALS confirmed by disease progression at follow-up. RESULTS: Of 404 eligible patients 272 were diagnosed as ALS, 94 had mimicking disorders, 35 were lost for follow-up, and three had insufficient data. Sensitivity for the GC criteria was 88.2% (95% CI: 83.8-91.8%), which was higher than for previous criteria, of which the AW + Poss criteria reached the highest sensitivity of 77.6% (95% CI: 72.2-82.4%) (p < 0.001). Specificity was high for all criteria. The increase in sensitivity for the GC criteria was mainly due to the inclusion of 28 patients with progressive muscular atrophy (PMA). CONCLUSIONS: The simpler GC criteria increase the sensitivity, primarily due to considering PMA as a form of ALS with high specificity preserved. SIGNIFICANCE: This validation study supports that GC criteria should be used in clinical practice and may be used for inclusion in trials.
OBJECTIVE: This study evaluates diagnostic accuracy of the proposed 'Gold Coast' (GC) diagnostic criteria for amyotrophic lateral sclerosis (ALS). METHODS: Five European centres retrospectively sampled consecutive patients referred for electromyography on suspicion of ALS. Patients were classified according to the GC criteria, the revised El Escorial (rEE) criteria and the Awaji (AW) criteria without and with the 'Possible' category (+ Poss). Reference standard was ALS confirmed by disease progression at follow-up. RESULTS: Of 404 eligible patients 272 were diagnosed as ALS, 94 had mimicking disorders, 35 were lost for follow-up, and three had insufficient data. Sensitivity for the GC criteria was 88.2% (95% CI: 83.8-91.8%), which was higher than for previous criteria, of which the AW + Poss criteria reached the highest sensitivity of 77.6% (95% CI: 72.2-82.4%) (p < 0.001). Specificity was high for all criteria. The increase in sensitivity for the GC criteria was mainly due to the inclusion of 28 patients with progressive muscular atrophy (PMA). CONCLUSIONS: The simpler GC criteria increase the sensitivity, primarily due to considering PMA as a form of ALS with high specificity preserved. SIGNIFICANCE: This validation study supports that GC criteria should be used in clinical practice and may be used for inclusion in trials.
Authors: Stephen A Goutman; Orla Hardiman; Ammar Al-Chalabi; Adriano Chió; Masha G Savelieff; Matthew C Kiernan; Eva L Feldman Journal: Lancet Neurol Date: 2022-03-22 Impact factor: 59.935