Leprous Neuropathy Screening: Field Testing of Sensory Testing Devices in Eucuador
Eric Wan, BS; Pablo A Baltodano, MD; Gedge D Rosson, MD; A Lee Dellon, MD
Plastic Surgery, Johns Hopkins University, Towson, MD
Objectives: Leprous neuritis represents an important cause of disability worldwide. Screening is typically performed with Semmes-Weinstein monofilament (SWMF) or ballpoint pen testing (BPT). However, important rates of under-diagnosis have been reported with these modalities. The Pressure-Specified Sensory DeviceTM (PSSD) has emerged as an effective way to assess peripheral nerve function. We aimed to determine the diagnostic accuracy of these three screening modalities.
Design: A cross-sectional study analyzed a consecutive sample of patients screened for Leprous neuritis during a mission trip to Los Ríos, Ecuador. Patients meeting the WHO criteria for Hansen’s disease and complaining of neuropathy symptoms were classified as Leprous neuritis patients. Patients without any sign of Hansen’s disease were used as controls. The same investigator performed bilateral ulnar nerve screening with the PSSD, SWMF (0.07g, 0.4g, 2g, 4g, 10g, 300g) and BPT in all patients. Sensitivity and specificity were calculated and compared across tests.
Results: A total of 71 patients (142 nerves) were evaluated. The mean age of the population was 39.4 ± 20.1 years. Three (4.2%) patients were excluded due to a potentially confounding cause of neuropathy (diabetes). Compared to the 10g SWMF and the BPT, the PSSD was found to have significantly higher sensitivity (78.3% vs. 0% with p<0.001, for both) with comparable specificity (97.8% vs. 100% with p>0.999, for both). Compared to the 0.07g SWMF (lightest in our series), the PSSD showed similar sensitivity (78.3% vs. 65.2%, p=0.514) but significantly higher specificity (97.8% vs. 51.1%, p<0.001).
Conclusions: The PSSD provides optimized diagnostic accuracy for detecting leprous neuritis compared to SWMF and BPT. Future prospective studies should assess the impact of early leprous neuritis management and should aim to determine the inter-rater variability associated with PSSD screening.
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