At the 2017 meeting of the American Association of Neuromuscular and Electrodiagnostic Medicine, the EMG was a common topic of discussion, as you might expect. But one particular session of interest focused on the EMG report and ways to improve its utility for the specialist, the referring physician, and in the end, the patient.
A previous post outlined Dr. Rubin’s discussion of how best to incorporate clinical information in the EMG report. Dr. Elizabeth Mauricio, a neurologist with the Mayo Clinic in Jacksonville, Florida, followed Dr. Rubin and discussed the importance of using precise and consistent language in the report.
She explained, for example, that EMG reporting of radiculopathies is not standardized. This means the terms used to describe radiculopathies can be unclear to referring physicians.
Researchers at the Mayo Clinic have made efforts to understand this issue and conducted a survey of 87 physicians who refer patients to the Mayo Clinic for EMG studies. The respondents represented a variety of specialties and included neurosurgeons, physiatrists, both neuromuscular and non-neuromuscular neurologists, internists and more.
The survey, reported in Muscle and Nerve, looked at the terminology used to describe an S1 radiculopathy, specifically assessing the understanding of the following terms:
- Acute active
- Chronic active
- Chronic inactive
- Chronic (used alone)
- Old with uncompensated denervation.
The survey respondents were asked to give their impression of how long the radiculopathy had been present and whether there was an ongoing process injuring the S1 root.
Acute active, chronic active, and chronic inactive were well understood by those surveyed. However, old, chronic, and old uncompensated were poorly understood by the respondents, which included physicians from a variety of specialties. It was not unfamiliarity with EMG reporting that created misunderstanding, but imprecision of language that was the culprit.
In light of these results, Dr. Mauricio recommends that specialists indicate whether there is ongoing nerve root injury for all radiculopathies using the following terminology:
- Active: There is ongoing nerve injury
- Likely Active: Clinical features are strongly suggestive of an ongoing process
- Inactive: There is an absence of ongoing nerve root injury
- Unclear based on EMG findings
Dr. Mauricio concluded that there is confusion in the meaning behind EMG reporting of radiculopathies. Clarity in reporting is important. At the specialty level, standardization is needed. Neurologists must work toward a reporting standard that will be widely used and understood by those who rely on their testing and clinical judgment.
Standardization won’t happen overnight. But on an individual level, ambiguous reporting may affect patient care and decisions about intervention. A specialist who writes clear, consistent reports provides a reliable standard for his referring physicians. This benefits everyone involved.
As you work on standardizing your EMG reporting language, look out for our post next month on what the EMG report should include.
This is Part 2 of a three-part recap of the session, EMG Reports: Issues of Report Formulation and Conveying Interpretation to Referring Physicians from the 2017 meeting of the American Association of Neuromuscular and Electrodiagnostic Medicine. You can read the Part 1, Creating an EMG Report to Benefit Your Referrers, and Part 3, How to Formulate an EMG Report for Utility and Reimbursement here on Neurology Insights.