Validation of the peroneal nerve test to diagnose critical illness polyneuropathy and myopathy in the intensive care unit: the multicentre Italian CRIMYNE-2 diagnostic accuracy study

Nicola Latronico, Giovanni Nattino, Bruno Guarneri, Nazzareno Fagoni, Aldo Amantini, Guido Bertolini, GiVITI Study Investigators, Nicola Latronico, Giovanni Nattino, Bruno Guarneri, Nazzareno Fagoni, Aldo Amantini, Guido Bertolini, GiVITI Study Investigators

Abstract

Objectives: To evaluate the accuracy of the peroneal nerve test (PENT) in the diagnosis of critical illness polyneuropathy (CIP) and myopathy (CIM) in the intensive care unit (ICU). We hypothesised that abnormal reduction of peroneal compound muscle action potential (CMAP) amplitude predicts CIP/CIM diagnosed using a complete nerve conduction study and electromyography (NCS-EMG) as a reference diagnostic standard.

Design: prospective observational study.

Setting: Nine Italian ICUs.

Patients: One-hundred and twenty-one adult (≥18 years) neurologic (106) and non-neurologic (15) critically ill patients with an ICU stay of at least 3 days.

Interventions: None.

Measurements and main results: PATIENTS underwent PENT and NCS-EMG testing on the same day conducted by two independent clinicians who were blind to the results of the other test. Cases were considered as true negative if both NCS-EMG and PENT measurements were normal. Cases were considered as true positive if the PENT result was abnormal and NCS-EMG showed symmetric abnormal findings, independently from the specific diagnosis by NCS-EMG (CIP, CIM, or combined CIP and CIM). All data were centrally reviewed and diagnoses were evaluated for consistency with predefined electrophysiological diagnostic criteria for CIP/CIM. During the study period, 342 patients were evaluated, 124 (36.3%) were enrolled and 121 individuals with no protocol violation were studied. Sensitivity and specificity of PENT were 100% (95% CI 96.1-100.0) and 85.2% (95% CI 66.3-95.8). Of 23 patients with normal results, all presented normal values on both tests with no false negative results. Of 97 patients with abnormal results, 93 had abnormal values on both tests (true positive), whereas four with abnormal findings with PENT had only single peroneal nerve neuropathy at complete NCS-EMG (false positive).

Conclusions: PENT has 100% sensitivity and high specificity, and can be used as a screening test to diagnose CIP/CIM in the ICU.

Conflict of interest statement

Competing interests: No competing interests were disclosed.

Figures

Figure 1.. Schematic representation of the peroneal…
Figure 1.. Schematic representation of the peroneal simplified electrophysiological test (PENT).
A normal compound muscle action potential (CMAP) amplitude is shown.
Figure 2.. Standards for Reporting of Diagnostic…
Figure 2.. Standards for Reporting of Diagnostic Accuracy (STARD) flowchart.

References

    1. Latronico N, Bolton CF: Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurol. 2011;10(10):931–41 10.1016/S1474-4422(11)70178-8
    1. De Jonghe B, Sharshar T, Lefaucheur JP, et al. : Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002;288(22):2859–67 10.1001/jama.288.22.2859
    1. Ali NA, O'Brien JM, Jr, Hoffmann SP, et al. : Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med. 2008;178(3):261–8 10.1164/rccm.200712-1829OC
    1. Latronico N, Shehu I, Guarneri B: Use of electrophysiologic testing. Crit Care Med. 2009;37(10 Suppl):S316–20 10.1097/CCM.0b013e3181b6f9f3
    1. Latronico N, Filosto M, Fagoni N, et al. : Small nerve fiber pathology in critical illness. PLoS One. 2013;8(9):e75696 10.1371/journal.pone.0075696
    1. Bolton CF: Neuromuscular manifestations of critical illness. Muscle Nerve. 2005;32(2):140–63 10.1002/mus.20304
    1. Latronico N, Fenzi F, Recupero D, et al. : Critical illness myopathy and neuropathy. Lancet. 1996;347(9015):1579–82 10.1016/S0140-6736(96)91074-0
    1. Leijten FS, Harinck-de Weerd JE, et al. : The role of polyneuropathy in motor convalescence after prolonged mechanical ventilation. JAMA. 1995;274(15):1221–5 10.1001/jama.1995.03530150045032
    1. Khan J, Harrison TB, Rich MM, et al. : Early development of critical illness myopathy and neuropathy in patients with severe sepsis. Neurology. 2006;67(8):1421–5 10.1212/01.wnl.0000239826.63523.8e
    1. Latronico N, Bertolini G, Guarneri B, et al. : Simplified electrophysiological evaluation of peripheral nerves in critically ill patients: the Italian multi-centre CRIMYNE study. Crit Care. 2007;11(1):R11 10.1186/cc5671
    1. Weber-Carstens S, Koch S, Spuler S, et al. : Nonexcitable muscle membrane predicts intensive care unit-acquired paresis in mechanically ventilated, sedated patients. Crit Care Med. 2009;37(9):2632–7 10.1097/CCM.0b013e3181a92f28
    1. Tennila A, Salmi T, Pettila V, et al. : Early signs of critical illness polyneuropathy in ICU patients with systemic inflammatory response syndrome or sepsis. Intensive Care Med. 2000;26(9):1360–3 10.1007/s001340000586
    1. Koch S, Spuler S, Deja M, et al. : Critical illness myopathy is frequent: accompanying neuropathy protracts ICU discharge. J Neurol Neurosurg Psychiatry. 2011;82(3):287–93 10.1136/jnnp.2009.192997
    1. Guarneri B, Bertolini G, Latronico N: Long-term outcome in patients with critical illness myopathy or neuropathy: the Italian multicentre CRIMYNE study. J Neurol Neurosurg Psychiatry. 2008;79(7):838–41 10.1136/jnnp.2007.142430
    1. Koch S, Wollersheim T, Bierbrauer J, et al. : Long term Recovery in Critical Illness Myopathy is complete, contrary to Polyneuropathy. Muscle Nerve. 2014. 10.1002/mus.24175
    1. Bossuyt PM, Reitsma JB, Bruns DE, et al. : The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med. 2003;138(1):W1–12 10.7326/0003-4819-138-1-200301070-00012-w1
    1. Bossuyt PM, Reitsma JB, Bruns DE, et al. : Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. BMJ. 2003;326(7379):41–4 10.1136/bmj.326.7379.41
    1. Holloway RG: Improving the flow of diagnostic information. The importance of STARD for authors and readers. Neurology. 2003;61:600–1 10.1212/01.WNL.0000089443.41909.C7
    1. Rossi C, Nattino G, Facchinetti S, et al. : Margherita-PROSAFE project. Promoting patient safety, research, and quality improvement in critical care medicine. Report 2012. Bergamo, Italy: Sestante edizioni;2013.
    1. Stevens RD, Dowdy DW, Michaels RK, et al. : Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med. 2007;33(11):1876–91 10.1007/s00134-007-0772-2
    1. Zamperetti N, Latronico N: Clinical research in critically ill patients: the situation in Italy. Intensive Care Med. 2008;34(7):1330–2 10.1007/s00134-008-1096-6
    1. Bolton CF: Electrophysiologic studies of critically ill patients. Muscle Nerve. 1987;10(2):129–35 10.1002/mus.880100205
    1. Bolton CF, Laverty DA, Brown JD, et al. : Critically ill polyneuropathy: electrophysiological studies and differentiation from Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry. 1986;49(5):563–73 10.1136/jnnp.49.5.563
    1. Witt NJ, Zochodne DW, Bolton CF, et al. : Peripheral nerve function in sepsis and multiple organ failure. Chest. 1991;99(1):176–84 10.1378/chest.99.1.176
    1. Daube JR: AAEM minimonograph #11: Needle examination in clinical electromyography. Muscle Nerve. 1991;14(8):685–700 10.1002/mus.880140802
    1. Petajan JH: AAEM minimonograph #3: motor unit recruitment. Muscle Nerve. 1991;14(6):489–502 10.1002/mus.880140602
    1. Latronico N, Peli E, Botteri M: Critical illness myopathy and neuropathy. Curr Opin Crit Care. 2005;11(2):126–32
    1. Buderer NM: Statistical methodology: I. Incorporating the prevalence of disease into the sample size calculation for sensitivity and specificity. Acad Emerg Med. 1996;3(9):895–900 10.1111/j.1553-2712.1996.tb03538.x
    1. Rich MM, Bird SJ, Raps EC, et al. : Direct muscle stimulation in acute quadriplegic myopathy. Muscle Nerve. 1997;20(6):665–73
    1. Goodman BP, Harper CM, Boon AJ: Prolonged compound muscle action potential duration in critical illness myopathy. Muscle Nerve. 2009;40(6):1040–2 10.1002/mus.21445
    1. van den Berghe G, Wouters P, Weekers F, et al. : Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345(19):1359–67 10.1056/NEJMoa011300
    1. Van den Berghe G, Wilmer A, Hermans G, et al. : Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354(5):449–61 10.1056/NEJMoa052521
    1. Moss M, Yang M, Macht M, et al. : Screening for critical illness polyneuromyopathy with single nerve conduction studies. Intensive Care Med. 2014;40(5):683–90 10.1007/s00134-014-3251-6
    1. Van den Berghe G, Schoonheydt K, Becx P, et al. : Insulin therapy protects the central and peripheral nervous system of intensive care patients. Neurology. 2005;64(8):1348–53 10.1212/01.WNL.0000158442.08857.FC
    1. Latronico N, Smith M: Introducing simplified electrophysiological test of peripheral nerves and muscles in the ICU: choosing wisely. Intensive Care Med. 2014;40(5):746–8 10.1007/s00134-014-3282-z
    1. Puthucheary ZA, Rawal J, McPhail M, et al. : Acute skeletal muscle wasting in critical illness. JAMA. 2013;310(15):1591–600 10.1001/jama.2013.278481
    1. Batt J, Dos Santos CC, Herridge MS: Muscle injury during critical illness. JAMA. 2013;310(15):1569–70 10.1001/jama.2013.278482
    1. Connolly BA, Jones GD, Curtis AA, et al. : Clinical predictive value of manual muscle strength testing during critical illness: an observational cohort study. Crit Care. 2013;17(5):R229 10.1186/cc13052
    1. Banwell BL, Mildner RJ, Hassall AC, et al. : Muscle weakness in critically ill children. Neurology. 2003;61(12):1779–82 10.1212/01.WNL.0000098886.90030.67
    1. Stevens RD, Marshall SA, Cornblath DR, et al. : A framework for diagnosing and classifying intensive care unit-acquired weakness. Crit Care Med. 2009;37(10 Suppl):S299–308 10.1097/CCM.0b013e3181b6ef67
    1. Hough CL, Lieu BK, Caldwell ES: Manual muscle strength testing of critically ill patients: feasibility and interobserver agreement. Crit Care. 2011;15(1):R43 10.1186/cc10005
    1. Eikermann M, Latronico N: What is new in prevention of muscle weakness in critically ill patients? Intensive Care Med. 2013;39(12):2200–3 10.1007/s00134-013-3132-4
    1. Bolton CF: Evidence of neuromuscular dysfunction in the early stages of the systemic inflammatory response syndrome. Intensive Care Med. 2000;26(9):1179–80 10.1007/s001340000622
    1. Zygun DA, Kortbeek JB, Fick GH, et al. : Non-neurologic organ dysfunction in severe traumatic brain injury. Crit Care Med. 2005;33(3):654–60 10.1097/01.CCM.0000155911.01844.54
    1. Christiansen CF, Johansen MB, Christensen S, et al. : Type 2 diabetes and 1-year mortality in intensive care unit patients. Eur J Clin Invest. 2013;43(3):238–47 10.1111/eci.12036
    1. Vinik AI, Nevoret ML, Casellini C, et al. : Diabetic neuropathy. Endocrinol Metab Clin North Am. 2013;42(4):747–87 10.1016/j.ecl.2013.06.001
    1. Perkins BA, Bril V: Diabetic neuropathy: a review emphasizing diagnostic methods. Clin Neurophysiol. 2003;114(7):1167–75 10.1016/S1388-2457(03)00025-7
    1. Latronico N, Nattino G, Guarneri B, et al. : Data set for the CRIMYNE-2 study on the validation of peroneal nerve test to diagnose polyneuropathy and myopathy in 121 patients. Figshare. 2014.

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