Chan, KH

Cheung, RTF

Fong, GCY

Ho, SL

Mak, W

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Title Sensory conduction parameters in assessing the severity ofcarpal tunnel syndromeAuthor(s) Mak, W; Chan, KH; Fong, GCY; Cheung, RTF; Ho, SLCitationThe 5th Medical Research Conference (MRC 2000), Hong Kong,China, January 2000. In The Hong Kong Practitioner, 2000, v. 22suppl. 2, p. 16Issued Date 2000URL http://hdl.handle.net/10722/46817Rights Creative Commons: Attribution 3.0 Hong Kong LicenseG-N-5Sensory Conduction Parameters in Assessing the Severity of Carpal Tunnel SyndromeMak W. Chan KH, Fong GCY, Cheung RTF, Ho SL. Division of Neurology, University Department of Medicine,Queen Mary Hospital.Background: Carpal tunnel syndrome (CTS) is diagnosed with sensory conduction abnormalities but its severity isconventionally graded by motor conduction abnormalities. Surgical decompression is generally recommended formoderate and severe cases and conservative treatment for mild cases. Objective: To study the role of sensoryconduction parameters in assessing the severity of CTS. Method: Consecutive patients with symptomatic CTS overone year were studied. The median nerve finger to wrist orthodromic sensory action potential (SAP) and sensoryconduction velocity (SVC) were recorded, as well as the standard motor parameters. AAEM criteria were appliedto grade CTS into mild, moderate, or severe. Unpaired t-test was used for statistical analysis.Results: One hundred and twenty three hands in 78 patients were studied. The mean SAP for mild (n=67), moderate(n=34), and severe (n=22) CTS were 18.3, 5.0, and 1.1 uV, respectively (SD 9.3, 5.8, and 2.4), and the mean SCVfor the three groups were 45.7, 30.2, and 23.2 m/sec, respectively (SD 5.3, 8.0, and 6.5). Sensory parameters weresignificantly different between mild and moderate CTS (p<0.0001 for both SAP and SCV), mild and severe CTS(p<0.0001 for both SAP and SCV), and moderate and severe CTS (p = 0.004 for SAP and 0.0014 for SCV). If onestandard deviation from mean SAP or SCV is set as the cutoff to distinguish mild from moderate or severe CTS, thesensitivity and specificity for SAP reduction are 89% and 93%, and for SCV slowing are 95% and 87%, respectively.Conclusion: From our results, sensory conduction abnormalities are both sensitive and specific in assessing theseverity of CTS in order to guide treatment decisions. Motor conduction studies may not be required for thispurpose, so that examination time and patient discomfort can be minimized. We recommend grading CTS as morethan mild if SAP is less than 9u V or SCV is less than 40 m/sec.G-RC-1PREDICTING INTENSIVE CARE OUTCOME : COMPARING THREE OUTCOME PREDICTIONMODELS, APACHE II, SAPS II, AND MPM IIWK Lam. Jane CK Chan, SM Chan, WM Chan, P Nelson, K Young, University Department of Medicine andIntensive Care Unit, Queen Mary Hospital, Hong Kong.Objectives:• To compare and evaluate three outcome prediction models APACHE II, SAPS, and MPM in predicting the outcomeof Adult Intensive Care Unit (AICU) patients at Queen Mary Hospital (QMH).• To examine the standard mortality ratios (SMR) of the QMH AICU over a period of two years based on the 3prediction models.Patients & Methods : 903 patients, first entry to AICU QMH were enrolled in 2 six-month periods between 1997-1999. All APACHE II, SAPS II and MPM II data were collected and analysed for probability of survival. Predictiveaccuracy is assessed with respect to calibration and discrimination. Calibration is measured using Lemeshow-Horsmer chi-square analysis, while discrimination is measured using the area under the ROC curve and the overallcorrect classification (OCC) rate.Results : Of the 903 patients (average age 60.4 yr), major diagnosis (%) were shock (23.7), and respiratory disorder(22.9). Average hospital mortality rate was 37.2%.APACHE II MPM IIo MPM II24_ SAPS IIChi-square 20.04 232.43 39.13 93.2AUC 0.847 0.732 0.804 0.839OCC rate 0.78 0.69 0.73 0.76SMR _ _1.05 1.65 _1.14 0.94Conclusions :• APACHE II and SAPS II methods are almost equally accurate, and both offer better calibration and discriminationpower than MPM II in predicting intensive care outcome.• In view of the complexity with APACHE II, SAPS II is recommended as the prediction method of choice forAICU.• Our AICU performance is comparable to international standards.Supported by Research Grant Council of Hong Kong- 16 -

Sensory conduction parameters in assessing the severity of carpal tunnel syndrome

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Sensory conduction parameters in assessing the severity of carpal tunnel syndrome

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