Evaluation of the adequacy of requests for electrodiagnostic examination in a tertiary referral center

• Our study demonstrated that a large proportion of referrals to EDX testing are inappropriate.
• Inappropriate referrals are often made by the non-neuromuscular specialists.
• We propose consultation by the neuromuscular specialist before referral to EDX testing.
• This approach is expected to shorten waiting lists and reduce costs.

ObjectiveDiagnostic procedures are often overused in the attempt to substitute for the good clinical examination. The aim of this study was to evaluate the type and the accuracy of the referral diagnosis to our EMG lab, as well as the impact of electrodiagnostic (EDX) examination on the diagnosis of our patients.MethodsIn this prospective study all patients examined in the six months period in a single tertiary referral EMG lab were analyzed. All patients were tested in a uniform fashion and by the same neurologist, according to the referral diagnosis.ResultsEDX examination was performed in 570 patients. Most of the patients (43.9%) were referred with the diagnosis of polyneuropathy, lumbosacral (23.7%) or cervical (11.2%) radiculopathy and myasthenia gravis (11.6%). The outcome after EDX examination was: diagnosis confirmation in 49.6% of patients, new clinically relevant diagnosis in 16%, incidental diagnosis in 4% and normal EDX examination in 36.1% of patients. EDX examination confirmed referral diagnosis more often in patients referred by neuromuscular neurologists, while normal EDX finding was reported more often in patients referred by other neurologists.ConclusionThis study has confirmed the inappropriateness of a large number of referrals to EDX testing, especially made by the non-neuromuscular neurologists.