• Beng L A Chew, David B Williams, and John Attia.
• Hunter New England Health, Newcastle, New South Wales, Australia.
• Intern Med J. 2022 May 1; 52 (5): 785-789.

BackgroundThe diagnosis of polyneuropathy usually requires neurophysiological investigation, necessitating specialised testing and interpretation thereby increasing the time to final diagnosis.AimsTo investigate the predictive value of the clinical examination in patients with potential neuropathies.MethodsPatients were recruited based on their referral requesting neurophysiological testing. Two examiners tested ankle jerk reflexes and gradient to temperature sensation prior to the patient undergoing neurophysiology investigations, blinded to subsequent testing results. The neurophysiology investigations were either standard nerve conduction study (NCS) or thermal threshold testing (TTT) or both. These data were then analysed to determine the Kappa between examiners as well as sensitivity, specificity, and positive and negative likelihood ratios.ResultsThere was a modest level of agreement between examiners for ankle jerk testing (Kappa = 0.6) but poor agreement for gradient temperature testing (Kappa = 0.3). Bilateral absence of ankle jerk reflexes was moderately associated with abnormal NCS, with the following characteristics: sensitivity 72%, specificity 91%, positive likelihood ratio 7.6 and negative likelihood ratio 0.3. The presence of a temperature gradient was poorly diagnostic for abnormal TTT: sensitivity 87%, specificity 14%, with positive and negative likelihood ratios close to 1.ConclusionThe absence of ankle jerks performed moderately well in identifying patients likely to have large-fibre neuropathy and could potentially be used to help decide who should be sent for NCS. Gradient temperature testing was much more subjective and did not change the likelihood of abnormal TTT.© 2020 Royal Australasian College of Physicians.

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