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A Comparison of Three Diagnostic Tests for Diagnosis of Carpal Tunnel Syndrome Using Latent Class Analysis
John R. Fowler, MD1; William Cipolli, MS2; Timothy Hanson, PhD
1University of Pittsburgh Medical Center, Pittsburgh, PA; 2University of South Carolina, Columbia, SC

Introduction: The current reference standard for carpal tunnel syndrome is under debate. Recent studies have demonstrated similar diagnostic accuracy between ultrasound and nerve conduction studies. The purpose of this study is to determine sensitivity and specificity of ultrasound (US), nerve conduction studies (NCS), and CTS-6 for diagnosis of carpal tunnel syndrome (CTS) using latent class analysis.

Methods: Latent class analysis (LCA) is a statistical technique that can be used to estimate the accuracy of diagnosis when there is no universally accepted reference standard. This type of analysis is useful in the setting of CTS as their remains significant controversy with respect to the necessity of NCS and other confirmatory testing. CTS-6 is a validated clinical diagnostic tool for diagnosis of CTS-6 that has been shown to have a high sensitivity and specificity. Data from a database of 85 consecutive patients with NCS, CTS-6 and US was analyzed using classical latent class analysis, assuming that the three tests were imperfect and conditionally independent.

Results: The sensitivities of US, CTS-6, and NCS were 91% (95%CI 81-97), 94% (95%CI 86-99), and 91% (95%CI 81-97), respectively. The specificities of US, CTS-6, and NCS were 94% (95%CI 80-100), 91% (95%CI 74-99), and 83% (95%CI 66-95), respectively.

Conclusion: US, NCS, and CTS-6 have similar sensitivity and specificity for the diagnosis of carpal tunnel syndrome. The currently accepted reference standard (NCS) had the lowest sensitivity and specificity of the three tests. These findings support previous studies that suggest CTS-6 and US are highly accurate in the diagnosis of CTS and that NCS are not necessary in most cases.

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