Using atypical symptoms and red flags to identify non-demyelinating disease.
Kelly, Siobhan B Chaila, Elijah Kinsella, Katie Duggan, Marguerite Walsh, Cathal Tubridy, Niall Hutchinson, Michael
Kelly, Siobhan B
Chaila, Elijah
Kinsella, Katie
Duggan, Marguerite
Walsh, Cathal
Tubridy, Niall
Hutchinson, Michael
Advisors
Editors
Other Contributors
Date
2012-01
Date Submitted
Keywords
Other Subjects
Subject Mesh
Brain
Diagnosis, Differential
Humans
Magnetic Resonance Imaging
Multiple Sclerosis
Nervous System Diseases
Referral and Consultation
Sensitivity and Specificity
Spinal Cord
Diagnosis, Differential
Humans
Magnetic Resonance Imaging
Multiple Sclerosis
Nervous System Diseases
Referral and Consultation
Sensitivity and Specificity
Spinal Cord
Planned Date
Start Date
Collaborators
Principal Investigators
Alternative Titles
Publisher
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.
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
ISSN
1468-330X
eISSN
ISBN
DOI
10.1136/jnnp-2011-300679
PMID
21849338
PMCID
Sponsorships
Funding Sources
Funding Amounts
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Methodology
Duration
Ethical Approval
N/A