Data_Sheet_1_Diagnostic performance of preoperative ultrasound for traumatic brachial plexus root injury: A comparison study with an electrophysiology study.PDF

PurposeAccurate preoperative assessment for traumatic brachial plexus injury (BPI) is critical for clinicians to establish a treatment plan. The objective of this study was to investigate the diagnostic performance of preoperative ultrasound (US) through comparison with an electrophysiology study (EPS) in the assessment of traumatic brachial plexus (BP) root injury.Materials and methodsWe performed a retrospective study in patients with traumatic BPI who had preoperative US and EPS, excluding obstetric palsy and other nontraumatic neuropathies. US examination was performed on an EPIQ 5 color Doppler equipment. EPS was performed on a Keypoint 9033A07 Electromyograph/Evoked Potentials Equipment, testing electromyography (EMG), nerve conduction studies (NCS), and somatosensory evoked potentials (SEP). Each BP root of all patients was assessed by US and EPS as completely injured or incompletely injured, respectively. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated based on the correlation with intraoperative findings. The accuracy of US and EPS were compared using the McNemar test. The added benefit of US was evaluated by comparing the sensitivity and specificity between the combined tests with EPS using the McNemar test.ResultsThis study included 49 patients with traumatic BPI who underwent BP surgeries from October 2018 to September 2022. Surgical exploration confirmed 89 completely injured BP roots in 28 patients. US correctly detected 80 completely injured BP roots (sensitivity, 0.899; specificity, 0.981; PPV, 0.964; NPV, 0.944; accuracy, 0.951). EPS correctly detected 75 completely injured BP roots (sensitivity, 0.843; specificity, 0.929; PPV, 0.872; NPV, 0.912; accuracy, 0.898). US showed significantly higher accuracy than EPS (p = 0.03). When combining US and EPS for completely injured BP root detection, the sensitivity of the inclusive combination (0.966) was significantly higher than EPS alone (p = 0.000977), and the specificity of the exclusive combination (1.000) was significantly higher than EPS alone (p = 0.000977).ConclusionPreoperative US is an effective diagnostic tool in the assessment of traumatic BP root injury. US had higher accuracy than EPS in this study. Sensitivity and specificity were significantly higher than EPS when US was combined with EPS.

目的：精确的术前评估对于创伤性臂丛神经损伤（BPI）至关重要，这对于临床医生制定治疗方案具有决定性意义。本研究旨在通过将术前超声（US）与电生理学检查（EPS）进行比较，来探究US在评估创伤性臂丛（BP）根损伤方面的诊断性能。材料与方法：我们对具有术前US和EPS的创伤性BPI患者进行了回顾性研究，排除了产科麻痹及其他非创伤性神经病变。超声检查在EPIQ 5彩色多普勒设备上进行。EPS在Keypoint 9033A07肌电图/诱发电位设备上进行，检测包括肌电图（EMG）、神经传导检查（NCS）和体感诱发电位（SEP）。所有患者的每个BP根均通过US和EPS分别评估为完全损伤或不完全损伤。敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确率均基于术中发现的关联性进行计算。US和EPS的准确性通过McNemar检验进行比较。US的附加益处通过比较结合EPS的联合测试的敏感性和特异性（使用McNemar检验）进行评估。结果：本研究包括2018年10月至2022年9月期间接受BP手术的49例创伤性BPI患者。手术探查证实28例患者中有89个BP根完全损伤。US正确检测到80个完全损伤的BP根（敏感性，0.899；特异性，0.981；PPV，0.964；NPV，0.944；准确率，0.951）。EPS正确检测到75个完全损伤的BP根（敏感性，0.843；特异性，0.929；PPV，0.872；NPV，0.912；准确率，0.898）。US的准确性显著高于EPS（p = 0.03）。当将US与EPS结合用于检测完全损伤的BP根时，包容性组合的敏感性（0.966）显著高于单独使用EPS（p = 0.000977），而排他性组合的特异性（1.000）也显著高于单独使用EPS（p = 0.000977）。结论：术前US是评估创伤性BP根损伤的有效诊断工具。在本研究中，US的准确性高于EPS。当US与EPS结合使用时，其敏感性和特异性显著高于EPS。