An Analysis of Surgeon Experience, Diagnostic Testing, and Treatment Recommendation For Carpal Tunnel Syndrome.

Autor:	Hooper RC; Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI. Electronic address: hooperra@med.umich.edu., Thompson N; University of Toledo College of Medicine and Life Sciences, Toledo, OH., Fan Z; Department of Surgery, University of Michigan Medical School, Ann Arbor, MI., Waljee JF; Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI., Sears ED; Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI; VA Center for Clinical Management and Research, Ann Arbor, MI.
Jazyk:	angličtina
Zdroj:	The Journal of hand surgery [J Hand Surg Am] 2024 Nov; Vol. 49 (11), pp. 1061-1067. Date of Electronic Publication: 2024 Aug 12.
DOI:	10.1016/j.jhsa.2024.06.012
Abstrakt:	Purpose: The diagnosis of carpal tunnel syndrome (CTS) can be made clinically using the Carpal Tunnel Syndrome-6 (CTS-6) criteria. The role of electrodiagnostic studies (EDS) is controversial. We examined differences in the utilization of CTS-6 and EDS based on surgeon experience and practice setting. Methods: Members of the American Society for Surgery of the Hand were emailed an anonymous web-based link to participate. The survey included an assessment of hypothetical CTS scenarios with varying clinical severity. We collected surgeon demographic attributes, years in practice, practice setting, and frequency of CTS-6 and EDS utilization. A comparison was made of years of experience with surgeon-reported utilization of CTS-6 and EDS as well as treatment recommendation. Results: We received 771 responses (25% response rate). Surgeons recommended carpal tunnel release (CTR) for patients without EDS (16%), normal EDS (33%), and abnormal EDS (90%). Fifty-three percent of surgeons with <15 years in practice reported often/always using CTS-6 criteria in their practice compared to 30% and 29% of surgeons with 16-30 years and > 30 years in practice, respectively. Surgeons with 16-30 and >30 years in practice had significantly lower odds of reporting often/almost always using CTS-6 relative to surgeons with 1-15 years in practice (OR 0.35 and 0.31, respectively). A greater proportion of surgeons with 16-30 years (68%) and >30 years (65.5%) in practice responded often/almost always applying EDS compared to surgeons with <15 years (56%) in practice. In addition, surgeons with 16-30 years and >30 years in practice had a higher odds of often/always using EDS (ORs 1.74 and 1.98, respectively) compared to surgeons with 1-15 years in practice (P < .05). Conclusions: Utilization of CTS-6 and EDS varied based on years in practice. This difference may reflect changing guidelines, the growing evidence regarding clinical assessment tools, and the emergence of other diagnostic modalities. Clinical Relevance: Given the expense and invasiveness of EDS, opportunities to integrate clinical assessment tools readily into the diagnostic algorithm may shift the role of EDS toward selective utilization for complex clinical scenarios rather than for routine use. Competing Interests: Conflicts of Interest No benefits in any form have been received or will be received related directly to this article. (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu