Diagnostic discordance between referral impressions, clinical assessment, and final electrodiagnostic findings.
- 1Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA.
Abstract
Objective
This study evaluated concordance between referral impressions, structured pre-test assessment, and electrodiagnostic findings (EDX), compared the concordance of an electrodiagnostic consultant's (EC) pre-test assessment and the referring clinician's impression with the final EDX diagnosis.Methods
A single-center, prospective observational study enrolled 104 participants over 9 months; 101 completed testing. The EC recorded a diagnostic impression before nerve conduction studies and needle electromyography (EMG). Final diagnoses were categorized using an ICD-10 root-based schema. Referral, pre-test, and final diagnoses were compared using exact agreement between the first-listed primary ICD-10 diagnosis codes.Results
Among 101 patients (mean age 59 years; 59.4% female), referral-final concordance was 34.7% (35/101), compared with 71.3% (72/101) for EC pre-test-final concordance (matched OR, 6.29; 95% CI, 2.81-16.54; p < 0.001). EDX produced a clinically meaningful diagnostic change in 67 patients (66.3%) and modified management in 53 (52.5%); subsequent implementation was not assessed. The EC pre-test diagnosis differed from the final EDX diagnosis in 29 cases (28.7%).Conclusions
EDX frequently identified diagnoses that differed from referral impressions and sometimes differed from the consultant's pre-test assessment. The higher pre-test-final concordance reflects within-clinician agreement after a focused history and examination; it does not establish that the electrodiagnostic consultant is more diagnostically accurate than referring clinicians.Significance
This single-center exploratory study supports the clinical value of a focused pre-test assessment and of EDX as a diagnostic consultation. Larger, multicenter studies using independent assessment are needed.
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BibTeX
@article{walkon2026diagnostic,
title = {{Diagnostic discordance between referral impressions, clinical assessment, and final electrodiagnostic findings.}},
author = {Lauren L Walkon and Daniel Menkes},
journal = {Clinical neurophysiology practice},
year = {2026},
month = oct,
doi = {10.1016/j.cnp.2026.09.008},
url = {https://europepmc.org/article/MED/42921148},
note = {CC BY},
}
RIS
TY - JOUR
TI - Diagnostic discordance between referral impressions, clinical assessment, and final electrodiagnostic findings.
AU - Lauren L Walkon
AU - Daniel Menkes
PY - 2026
DA - 2026/10/12
JO - Clinical neurophysiology practice
DO - 10.1016/j.cnp.2026.09.008
UR - https://europepmc.org/article/MED/42921148
AB - Objective This study evaluated concordance between referral impressions, structured pre-test assessment, and electrodiagnostic findings (EDX), compared the concordance of an electrodiagnostic consultant's (EC) pre-test assessment and the referring clinician's impression with the final EDX diagnosis.Methods A single-center, prospective observational study enrolled 104 participants over 9 months; 101 completed testing. The EC recorded a diagnostic impression before nerve conduction studies and needle electromyography (EMG). Final diagnoses were categorized using an ICD-10 root-based schema. Referral, pre-test, and final diagnoses were compared using exact agreement between the first-listed primary ICD-10 diagnosis codes.Results Among 101 patients (mean age 59 years; 59.4% female), referral-final concordance was 34.7% (35/101), compared with 71.3% (72/101) for EC pre-test-final concordance (matched OR, 6.29; 95% CI, 2.81-16.54; p < 0.001). EDX produced a clinically meaningful diagnostic change in 67 patients (66.3%) and modified management in 53 (52.5%); subsequent implementation was not assessed. The EC pre-test diagnosis differed from the final EDX diagnosis in 29 cases (28.7%).Conclusions EDX frequently identified diagnoses that differed from referral impressions and sometimes differed from the consultant's pre-test assessment. The higher pre-test-final concordance reflects within-clinician agreement after a focused history and examination; it does not establish that the electrodiagnostic consultant is more diagnostically accurate than referring clinicians.Significance This single-center exploratory study supports the clinical value of a focused pre-test assessment and of EDX as a diagnostic consultation. Larger, multicenter studies using independent assessment are needed.
SN - 2467-981X
ER -