Using atypical symptoms and red flags to identify non-demyelinating disease.

Hdl Handle:
http://hdl.handle.net/10147/217634
Title:
Using atypical symptoms and red flags to identify non-demyelinating disease.
Authors:
Kelly, Siobhan B; Chaila, Elijah; Kinsella, Katie; Duggan, Marguerite; Walsh, Cathal; Tubridy, Niall; Hutchinson, Michael
Affiliation:
Department of Neurology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
Citation:
Using atypical symptoms and red flags to identify non-demyelinating disease. 2012, 83 (1):44-8 J. Neurol. Neurosurg. Psychiatr.
Journal:
Journal of neurology, neurosurgery, and psychiatry
Issue Date:
Jan-2012
URI:
http://hdl.handle.net/10147/217634
DOI:
10.1136/jnnp-2011-300679
PubMed ID:
21849338
Abstract:
Red flags and atypical symptoms have been described as being useful in suggesting alternative diagnoses to multiple sclerosis (MS) and clinically isolated syndrome (CIS); however, their diagnostic utility has not been assessed. The aim of this study was to establish the predictive value of red flags and the typicality/atypicality of symptoms at presentation in relation to the final diagnosis of patients referred with suspected MS.; All patients referred with suspected MS over a 3-year period were assessed by the typicality of the clinical presentation and the occurrence of red flags in relation to the eventual diagnosis. The extent of agreement of trainee and consultant neurologists as to typicality of clinical presentations was determined.; Of 244 patients referred, 119 (49%) had MS/CIS and 125 (51%) did not. 41 patients were referred because of an abnormal MRI. Of 203 with clinical symptoms, 96 patients had atypical symptoms of whom, 81 (84%) did not have MS and 15 (16%) had MS/CIS. Typical symptoms occurred in 107 patients; 10% did not have MS/CIS. Atypical symptoms had a sensitivity of 84%, specificity of 90% and positive likelihood ratio (PLR) of 8.4, whereas red flags had a sensitivity of 47%, specificity of 88% and PLR of 3.9 for the exclusion of MS/CIS. Mean percentage agreement between consultants and trainees was 73% with a range of 32-96%.; Atypical features at presentation are more sensitive, specific and have a higher PLR than red flags to refute a diagnosis of MS/CIS.
Language:
en
MeSH:
Brain; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Multiple Sclerosis; Nervous System Diseases; Referral and Consultation; Sensitivity and Specificity; Spinal Cord
ISSN:
1468-330X
Ethical Approval:
N/A

Full metadata record

DC FieldValue Language
dc.contributor.authorKelly, Siobhan B-
dc.contributor.authorChaila, Elijah-
dc.contributor.authorKinsella, Katie-
dc.contributor.authorDuggan, Marguerite-
dc.contributor.authorWalsh, Cathal-
dc.contributor.authorTubridy, Niall-
dc.contributor.authorHutchinson, Michael-
dc.date.accessioned2012-04-04T11:14:42Z-
dc.date.available2012-04-04T11:14:42Z-
dc.date.issued2012-01-
dc.identifier.citationUsing atypical symptoms and red flags to identify non-demyelinating disease. 2012, 83 (1):44-8 J. Neurol. Neurosurg. Psychiatr.-
dc.identifier.issn1468-330X-
dc.identifier.pmid21849338-
dc.identifier.doi10.1136/jnnp-2011-300679-
dc.identifier.urihttp://hdl.handle.net/10147/217634-
dc.description.abstractRed flags and atypical symptoms have been described as being useful in suggesting alternative diagnoses to multiple sclerosis (MS) and clinically isolated syndrome (CIS); however, their diagnostic utility has not been assessed. The aim of this study was to establish the predictive value of red flags and the typicality/atypicality of symptoms at presentation in relation to the final diagnosis of patients referred with suspected MS.-
dc.description.abstractAll patients referred with suspected MS over a 3-year period were assessed by the typicality of the clinical presentation and the occurrence of red flags in relation to the eventual diagnosis. The extent of agreement of trainee and consultant neurologists as to typicality of clinical presentations was determined.-
dc.description.abstractOf 244 patients referred, 119 (49%) had MS/CIS and 125 (51%) did not. 41 patients were referred because of an abnormal MRI. Of 203 with clinical symptoms, 96 patients had atypical symptoms of whom, 81 (84%) did not have MS and 15 (16%) had MS/CIS. Typical symptoms occurred in 107 patients; 10% did not have MS/CIS. Atypical symptoms had a sensitivity of 84%, specificity of 90% and positive likelihood ratio (PLR) of 8.4, whereas red flags had a sensitivity of 47%, specificity of 88% and PLR of 3.9 for the exclusion of MS/CIS. Mean percentage agreement between consultants and trainees was 73% with a range of 32-96%.-
dc.description.abstractAtypical features at presentation are more sensitive, specific and have a higher PLR than red flags to refute a diagnosis of MS/CIS.-
dc.language.isoen-
dc.rightsArchived with thanks to Journal of neurology, neurosurgery, and psychiatryen_GB
dc.subject.meshBrain-
dc.subject.meshDiagnosis, Differential-
dc.subject.meshHumans-
dc.subject.meshMagnetic Resonance Imaging-
dc.subject.meshMultiple Sclerosis-
dc.subject.meshNervous System Diseases-
dc.subject.meshReferral and Consultation-
dc.subject.meshSensitivity and Specificity-
dc.subject.meshSpinal Cord-
dc.titleUsing atypical symptoms and red flags to identify non-demyelinating disease.en_GB
dc.contributor.departmentDepartment of Neurology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.-
dc.identifier.journalJournal of neurology, neurosurgery, and psychiatry-
dc.type.qualificationlevelN/Aen
cr.approval.ethicalN/Aen
dc.description.provinceLeinsteren
dc.description.provinceLeinster-

Related articles on PubMed

All Items in Lenus, The Irish Health Repository are protected by copyright, with all rights reserved, unless otherwise indicated.