The Diagnostic Sensitivity, Specificity and Reproducibility of the Clinical Physical Examination Signs in Patients of Diabetes Mellitus for Making Diagnosis of Peripheral Neuropathy
Bibliographic record
Abstract
Background : Diabetes mellitus is one of the most common chronic diseases. Prevalence of neuropathy in type 1 and type 2 diabetes is as high as 66% and 59% respectively. As underdiagnosis of neuropathy is common in clinical practice, we plan to identify the symptoms and signs which either alone or in combination have the best predictive value. The research question for the current study is that in patients with diabetes mellitus (type 1 and type 2) what is the diagnostic accuracy of physical signs in the diagnosis of peripheral neuropathy, as compared to the electro-diagnostic test (nerve conduction studies, NCS) as a reference standard and the reliability of these physical signs as a bedside examination tool. Methods : The study was conducted at Mahatma Gandhi Institute of Medical Sciences, Sevagram. For a period of two months (May - June 2009) we prospectively identified all consecutive patients of diabetes mellitus (type 1 and type 2) admitted to the medicine wards. The clinical signs were evaluated in each of the two lower limbs of all patients by two observers blinded to each other. And then patients underwent electrodiagnostic studies done by the trained technician and interpreted by a trained physician. Results : Absent ankle reflex was the most sensitive sign to detect neuropathy of any type. Impairment of vibration had the highest specificity. None of the physical signs alone had sufficiently high positive likelihood ratio to significantly increase the post-test probability of neuropathy with the sign being positive. Similarly none of the signs by itself had a low negative likelihood ratio to be able to rule out neuropathy. The interobserver reproducibility of the physical signs was moderate to poor. Impaired vibration test had a fair agreement between the two observers. Conclusions : Our study implies the annual foot examination of the diabetes irrespective of the duration of the diabetes. In clinical practice, however electrophysiological tests should not replace clinical examination because NCS has many pitfalls and the interpretation of the results should be done in the context of clinical data. J Endocrinol Metab. 2011;1(1):21-26 doi: https://doi.org/10.4021/jem101e
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".