目的:2016年美国骨科医师学会(AAOS)临床实践指南(CPG)强调了腕管综合征(CTS)电诊断研究(EDS)的必要性。我们检验了AAOSCPG后EDS的使用减少的假设。
方法:使用国家行政索赔数据库,我们测量了2011年至2019年诊断为CTS的患者在诊断后1年内接受EDS的比例.使用中断的时间序列设计,我们定义了2个时间段(CPG前和CPG后),并使用分段回归分析比较了这两个时间段之间的EDS使用情况.我们对腕管松解术患者的术前EDS使用情况进行了亚组分析。
结果:在2,081,829例CTS患者中,315,449(15.2%)在诊断后1年内发生EDS。分段回归分析显示,发布AAOSCPG后,EDS的使用水平下降(每1,000名患者-11.50[95%CI,每1,000名患者-1.47至-0.95]);然而,在CPG后期间,EDS使用率增加(每1,000名患者每季度+1.75[95%CI,每1,000名患者每季度0.97~2.54]).在473,753名接受腕管松解术的合格患者中,手术前6个月内行EDS139186例(29.4%)。AAOSCPG发布后,术前EDS使用率下降-23.57/1,000例患者(95%CI,-37.72至-9.42/1,000例患者).然而,EDS使用的这些下降趋势早于2016年AAOSCPG。
结论:至少自2014年以来,CTS的总体和术前EDS使用率一直在下降,早于2016年AAOSCPG,反映了证据在实践中的快速实施。然而,在CPG后期间,EDS的使用量有所增加,相当比例的腕管松解术患者仍接受EDS治疗。
结论:鉴于其高成本和有争议的价值,应考虑常规EDS的使用,以进一步取消实施计划。
A 2016 American Academy of Orthopaedic Surgeons (AAOS) clinical practice
guideline (CPG) de-emphasized the need for electrodiagnostic studies (EDS) for carpal tunnel syndrome (CTS). We tested the hypothesis that use of EDS decreased after the AAOS CPG.
Using a national administrative claims database, we measured the proportion of patients with a diagnosis of CTS who underwent EDS within 1 year after diagnosis between 2011 and 2019. Using an interrupted time series design, we defined 2 time periods (pre-CPG and post-CPG) and compared EDS usage between the periods using segmented regression analysis. We conducted a subgroup analysis of preoperative EDS usage in patients who underwent carpal tunnel release.
Of 2,081,829 patients with CTS, 315,449 (15.2%) underwent EDS within 1 year after diagnosis. The segmented regression analysis showed a decrease in the level of EDS usage after publication of the AAOS CPG (-11.50 per 1,000 patients [95% CI, -1.47 to -0.95 per 1,000 patients]); however, the rate of EDS usage increased in the post-CPG period (+1.75 per 1,000 patients per quarter [95% CI, 0.97-2.54 per 1,000 patients per quarter]). Of 473,753 eligible patients who underwent carpal tunnel release, 139,186 (29.4%) underwent EDS within 6 months before surgery. After publication of the AAOS CPG, preoperative EDS usage decreased by -23.57 per 1,000 patients (95% CI, -37.72 to -9.42 per 1,000 patients). However, these decreasing trends in EDS usage predated the 2016 AAOS CPG.
The overall and preoperative EDS usage for CTS has been decreasing since at least 2014, predating the 2016 AAOS CPG, reflecting the rapid implementation of evidence into practice. However, EDS usage has increased in the post-CPG period, and a considerable proportion of patients who underwent carpal tunnel release still received EDS.
Given its high costs and disputed value, routine EDS usage should be considered for further deimplementation initiatives.