TY - JOUR
T1 - Which Tests Should Be Routinely Ordered Prior to Brachial Plexus Reconstruction? Results of a Delphi Panel
AU - Dy, Christopher J.
AU - Antes, Alison L.
AU - Sisk, Bryan A.
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024
Y1 - 2024
N2 - Background: There are notable differences in how adult patients with traumatic brachial plexus injuries (BPI) are evaluated and treated. Purpose: To better understand existing philosophies, we used the Delphi method to measure and foster consensus on routine use of electrodiagnostic testing, ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) myelograms prior to surgery. Panelists were 10 peripheral nerve surgeons board certified in their respective specialties at 5 academic medical centers in the United States. Methods: We presented 2 cases (1 complete/pan-BPI and 1 upper trunk BPI) to panelists and asked how often they would order the following preoperative diagnostic tests: electrodiagnostic studies; ultrasound of the brachial plexus; MRI of the brachial plexus; CT myelogram. Our Delphi process included an initial survey with videoconference discussion after the first round. A second survey/videoconference round was conducted to further probe the items that did not reach consensus during the first round. Results: Among the 10 surgeons, there was consensus that prior to brachial plexus surgery electrodiagnostic studies and MRI should be routinely ordered and ultrasound of the brachial plexus should not be routinely ordered. The group did not reach consensus on whether CT myelogram should or should not be routinely ordered. Conclusions: Based on our panel’s discussion, future work should focus on comparing the accuracy of CT myelogram and MRI for evaluation of cervical nerve root presence and viability.
AB - Background: There are notable differences in how adult patients with traumatic brachial plexus injuries (BPI) are evaluated and treated. Purpose: To better understand existing philosophies, we used the Delphi method to measure and foster consensus on routine use of electrodiagnostic testing, ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) myelograms prior to surgery. Panelists were 10 peripheral nerve surgeons board certified in their respective specialties at 5 academic medical centers in the United States. Methods: We presented 2 cases (1 complete/pan-BPI and 1 upper trunk BPI) to panelists and asked how often they would order the following preoperative diagnostic tests: electrodiagnostic studies; ultrasound of the brachial plexus; MRI of the brachial plexus; CT myelogram. Our Delphi process included an initial survey with videoconference discussion after the first round. A second survey/videoconference round was conducted to further probe the items that did not reach consensus during the first round. Results: Among the 10 surgeons, there was consensus that prior to brachial plexus surgery electrodiagnostic studies and MRI should be routinely ordered and ultrasound of the brachial plexus should not be routinely ordered. The group did not reach consensus on whether CT myelogram should or should not be routinely ordered. Conclusions: Based on our panel’s discussion, future work should focus on comparing the accuracy of CT myelogram and MRI for evaluation of cervical nerve root presence and viability.
KW - Delphi panel
KW - brachial plexus injury
KW - nerve reconstruction
KW - peripheral nerve injury
UR - http://www.scopus.com/inward/record.url?scp=85186596211&partnerID=8YFLogxK
U2 - 10.1177/15563316241234336
DO - 10.1177/15563316241234336
M3 - Article
AN - SCOPUS:85186596211
SN - 1556-3316
JO - HSS Journal
JF - HSS Journal
ER -