Diagnostic Accuracy of Hand Surgeons and Pain Specialists in Diagnosing CRPS Based on the Budapest Criteria

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Abstract

Abstract BackgroundThe clinical presentation of complex regional pain syndrome is heterogenous. The Budapest criteria give a list of symptoms and signs for the diagnosis. But the physician will often set the diagnosis clinically from the collection of symptoms and his or her experience. This study examines the accuracy of hand surgeons and pain specialists for diagnosing CRPS using the Budapest criteria as reference.MethodsWe included 124 patients of which 120 were diagnosed CRPS either by a clinician or by Budapest criteria. We analysed epidemiologic data, the number of patients with CRPS and mode of diagnosis and determined the CRPS severity score. Sensitivity, specificity, accuracy, and predictive values were calculated for hand surgeon and pain specialist. The number of CRPS-NOS was determined. We calculated the agreement between hand surgeon and pain specialist for the diagnosis CRPS.ResultsThe Budapest criteria were met in 108 cases with a mean CSS of 10.41 points. Sensitivity of hand surgeons for the diagnosis CRPS was 92 %, specificity 31 % and accuracy 90 %. The pain specialists had a sensitivity of 74 %, specificity of 71 % and accuracy of 74 %. Prevalence of CRPS-NOS was 9 %. In cases where hand surgeon and pain specialist agreed on CRPS, the Budapest criteria were met in 96 %, in all other combinations they were met in around 70 %. The agreement of hand surgeon and pain specialist was fair.ConclusionThe Budapest criteria can support the diagnosis CRPS in clinically ambiguous cases as they were most often met in cases with agreement of both clinicians. Care must be taken not to miss patients with CRPS-NOS.Trial registrationThe study was registered in the German Clinical Trials Register: DRKS00020348Universal Trial Number (UTN): U1111-1245-4109