Example: quiz answers

Validation of proposed diagnostic criteria (the â ...

Validation of proposed diagnostic criteria (the Budapest criteria )for complex regional pain SyndromeR. Norman Hardena,*, Stephen Bruehlb, Roberto Perezc,d, Frank Birkleine, Johan Marinusd,f,Christian Maihofnerg, Timothy Lubenowh, Asokumar Buvanendranh, Sean Mackeyi, Joseph Graciosaa,Mila Mogilevskia, Christopher Ramsdena, Melissa Chontb, Jean-Jacques VatinejaRehabilitation Institute of Chicago, Chicago, IL, USAbVanderbilt University School of Medicine, Nashville, TN, USAcVU University Medical Center, Amsterdam, The NetherlandsdTrauma Related Neuronal Dysfunction Consortium (TREND)

Validation of proposed diagnostic criteria (the ‘‘Budapest Criteria”) for Complex Regional Pain Syndrome R. Norman Harden a,* , Stephen Bruehl b , Roberto S.G.M. Perez c,d , Frank Birklein e , Johan Marinus d,f ,

Tags:

  Proposed, Validation, Criteria, Syndrome, Regional, Complex, Pain, Diagnostics, Complex regional pain syndrome, Validation of proposed diagnostic criteria

Information

Domain:

Source:

Link to this page:

Please notify us if you found a problem with this document:

Other abuse

Transcription of Validation of proposed diagnostic criteria (the â ...

1 Validation of proposed diagnostic criteria (the Budapest criteria )for complex regional pain SyndromeR. Norman Hardena,*, Stephen Bruehlb, Roberto Perezc,d, Frank Birkleine, Johan Marinusd,f,Christian Maihofnerg, Timothy Lubenowh, Asokumar Buvanendranh, Sean Mackeyi, Joseph Graciosaa,Mila Mogilevskia, Christopher Ramsdena, Melissa Chontb, Jean-Jacques VatinejaRehabilitation Institute of Chicago, Chicago, IL, USAbVanderbilt University School of Medicine, Nashville, TN, USAcVU University Medical Center, Amsterdam, The NetherlandsdTrauma Related Neuronal Dysfunction Consortium (TREND)

2 , Leiden University Medical Center, Leiden, The NetherlandseUniversity Medical Center Mainz, Mainz, GermanyfLeiden University Medical Center, Leiden, The NetherlandsgUniversity of Erlangen-Nuremberg, Erlangen, GermanyhRush University Medical Center, Chicago, IL, USAiStanford University Medical Center, Stanford, CA, USAjReuth Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israelarticle infoArticle history:Received 18 November 2009 Received in revised form 19 March 2010 Accepted 20 April 2010 Keywords: complex regional pain SyndromeReflex sympathetic dystrophyCRPSRSDD iagnosisValidationabstractCurrent IASP diagnostic criteria for CRPS have low specificity, potentially leading to overdiagnosis.

3 Thisvalidation study compared current IASP diagnostic criteria for CRPS to proposed new diagnostic criteria (the Budapest criteria ) regarding diagnostic accuracy. Structured evaluations of CRPS-related signs andsymptoms were conducted in 113 CRPS-I and 47 non-CRPS neuropathic pain patients. Discriminatingbetween diagnostic groups based on presence of signs or symptoms meeting IASP criteria showed highdiagnostic sensitivity ( ), but poor specificity ( ), replicating prior work. In comparison, the Buda-pest clinical criteria retained the exceptional sensitivity of the IASP criteria ( ), but greatly improvedupon the specificity ( ).

4 As designed, the Budapest research criteria resulted in the highest specificity( ), again replicating prior work. Analyses indicated that inclusion of four distinct CRPS components inthe Budapest criteria contributed to enhanced specificity. Overall, results corroborate the validity of theBudapest criteria and suggest they improve upon existing IASP diagnostic criteria for CRPS. 2010 International Association for the Study of pain . Published by Elsevier All rights IntroductionThe historical literature regarding the disorder now calledComplexRegionalPainSyndrome(CRPS)r eflectsanarrayofidiosyn-cratic diagnostic schemes[1,4,11,17,28,35].

5 In response, an interna-tional meeting was held in 1993 in Orlando, Florida to developconsensus terminology ( , CRPS) and standardized diagnostic cri-teria to improveclinicalrecognitionof the disorderand facilitatetheselectionofmoregeneralizabl eresearchsamples[33,36].Sincepub-licatio n of these consensus-based criteria by the International Asso-ciation for the Study of pain (IASP)[23], the extent of their use in theclinical setting is unknown, but their application in the researchsetting has been shown to be inconsistent[28].Despite the inherentadvantages of havingstandardized, interna-tionally-recognized diagnostic criteria for CRPS, it has been sug-gested that a lack of proven validity may be a barrier to their useby researchers and clinicians[6,13,17].

6 Incomplete understandingof CRPS pathophysiology and the resulting lack of a gold standard test make the design of Validation studies more challenging[6,28].However, studies conducted to date suggest that the IASP criteriafor CRPS suffer from a lack of specificity[6,10,13]. That is, whilethe IASP criteria may accurately identify most cases of CRPS, theyalso tend to misidentify non-CRPS neuropathic pain conditions asCRPS, potentially contributing to overdiagnosis and either inappro-priate or unnecessary treatments[6,13]. This inadequate specificityresults from the fact that the IASP CRPS criteria can be met solelybased on self-reported symptoms (which can be historical), andthe use of overly liberal decision rules; for instance requiring onlythe report of edema and pain seemingly out of proportion to theinjury as sufficient to make the diagnosis[6,10,13,23].

7 Failure ofthe IASP criteria to incorporate motor and trophic features0304-3959/$ 2010 International Association for the Study of pain . Published by Elsevier All rights *Corresponding author. Address: Center for pain Studies, Rehabilitation Instituteof Chicago, 446 E. Ontario, Suite 1011, Chicago, IL 60611, USA. Tel.: +1 312 2387878; fax: +1 312 238 Harden). 150 (2010) 268 274commonly associated with CRPS also may adversely impact diag-nostic accuracy[6,13].To address these limitations, an international consensus meet-ing was held in Budapest in 2003 to review issues related to CRPS diagnosis with the goal of recommending improvements to theIASP criteria (Ref.

8 [12]; seeAppendix Ifor a list of participants).The resulting proposal for modified diagnostic criteria for CRPS(the Budapest criteria ) was based primarily on empirically-de-rived criteria published previously[6,13]. Research evaluatingthese empirically-derived criteria since their publication in 1999indicates they result in improved diagnostic consistency betweenclinicians (kappa = ) compared to existing IASP criteria (kappa = )[9]. Moreover, these modified criteria resultin less frequent diagnoses of CRPS[9,27], potentially reflecting im-proved specificity.

9 However, no published studies have yet directlycompared the current standard IASP criteria to these proposedBudapest criteria vis- -vis diagnostic sensitivity and a manner similar to our prior published work[6,10], this studysought to compare the relative diagnostic efficiency of these alter-native diagnostic criteria in discriminating between CRPS and non-CRPS neuropathic pain DesignAn international, multi-site, between-subjects design was usedto compare the ability of the IASP and Budapest diagnostic criteriato distinguish between CRPS-I and non-CRPS neuropathic SubjectsSubjects included a series of 113 CRPS-I patients and 47 patientswith non-CRPS neuropathic pain ( non-CRPS )

10 Who presented forevaluation and treatment at the data collection sites. Due to theclinical nature of the sample accrual, matching of CRPS and non-CRPS groups in terms of sample size, type of initiating injury, orother relevant characteristics was not possible. The CRPS samplefor this study was restricted to CRPS-I patients to maximize samplehomogeneity given the small proportion of CRPS-II patients in theoverall sample (13%) which prevented separate analyses by CRPS subtype. Non-CRPS neuropathic pain affecting the limbs appearedto be the most appropriate comparison group given that CRPS-I isassociated with signs and symptoms characteristic of other knownneuropathic pains ( , allodynia, hyperalgesia) and evidence thatCRPS-I may be associated with some type of peripheral nerve in-jury[2,24].


Related search queries