The review of systems questionnaire discriminates medically unexplained neurologic symptoms from neurologic disease in a multiple sclerosis referral clinic
Author(s): ,
B. Jones
Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
W. Kilgo
Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
J. Rinker
Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
ECTRIMS Online Library. Jones B. Oct 12, 2018; 228818
Benjamin Jones
Benjamin Jones
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Abstract: P976

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis

Distinguishing multiple sclerosis (MS) from medically unexplained symptoms (MUS) is a major challenge for specialty MS clinics. Misdiagnosis of MS may expose patients to medical, psychological, social, and financial harm. Overreliance on testing such as MRI may lead to over diagnosis of MS. Focusing on aspects of the face-to-face encounter may improve discrimination between neurologic disease and MUS.
The review of systems (ROS) is used to collect information about symptoms affecting a range of organ systems. Patients responding “yes” to a high percentage of ROS items have been shown to correlate with MUS in specialty clinics in otolaryngology, gastroenterology, and epilepsy. Presented here are the results of a retrospective review from a specialty MS clinic examining the utility of the ROS in predicting the presence of MUS.
Consecutive new patients seen in the University of Alabama MS Clinic from 1 October 2017 through 31 March 2018 were included. Demographics, reason for referral, and final diagnosis were collected in addition to ROS questionnaires. Those without a completed ROS were excluded. Subjects were dichotomized by the presence or absence of MUS by physician impression. ROS “yes” responses were converted to a “percent positive response (PPR)” score for each subject. Odds ratios predicting MUS by PPR were determined by logistic regression. A receiver operating characteristic (ROC) curve was constructed to assess strength of ROS in diagnosing MUS, and sensitivity and specificity of ROS were reviewed for varying PPR cutoffs. All statistical analyses were performed using JMP 13.0.
Of 384 encounters, 166 completed ROS questionnaires, and 27 (16.2%) had MUS. Subjects were 76.5% female, 74.1% white, and mean age was 47.4 ± 13.8 years. Mean ROS PPR was 38.7 ± 18.75% for subjects with MUS and 23.8 ± 15.9% for all others. Odds ratio (OR) per unit change in PPR as a univariate predictor of MUS was 0.93 (p< 0.001). In a multivariate model, age, sex, and ethnicity did not predict MUS. Area under the ROC curve for PPR on ROS was 0.76. When subjects responded “yes” to >45% of items, ROS predicted MUS with 52% sensitivity and 94% specificity.
Patients with high PPR on ROS questionnaire are likely to have MUS. The ROS is a valuable, specific, and inexpensive tool to employ in the evaluation for MS or related disorders. While clinical judgement remains paramount, high PPR on ROS should act as a “red flag” for MUS.
Disclosure: Benjamin Jones receives salary support for fellowship training through an institutional grant from Biogen. William Kilgo reports no disclosures. John Rinker receives research funding from Biogen for an unrelated study.

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