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The Effectiveness of Post-Offer Pre-Placement Nerve Conduction Screening for Carpal Tunnel Syndrome

Dale, Ann Marie PhD, OTR/L; Gardner, Bethany T. OTD, OTR/L; Zeringue, Angelique MS; Werner, Robert MD, MS; Franzblau, Alfred MD; Evanoff, Bradley MD, MPH

Journal of Occupational and Environmental Medicine: August 2014 - Volume 56 - Issue 8 - p 840–847
doi: 10.1097/JOM.0000000000000185
Original Articles

Objective: We evaluated post-offer pre-placement (POPP) nerve conduction studies (NCS) for carpal tunnel syndrome (CTS), testing diagnostic yield and cost-effectiveness.

Methods: A total of 1027 newly hired workers underwent baseline NCS and were followed for an average of 3.7 years for diagnosed CTS. Measures of diagnostic yield included sensitivity, specificity, and positive predictive value (PPV). Cost-effectiveness of POPP screening was evaluated using a range of inputs.

Results: Abnormal NCS was strongly associated with future CTS with univariate hazard ratios ranging from 2.95 to 11.25, depending on test parameters used. Nevertheless, PPV was poor, 6.4% to 18.5%. Cost-effectiveness of POPP varied with CTS case costs, screening costs, and NCS thresholds.

Conclusions: Although abnormal NCS at hire increases risk of future CTS, the PPV is low, and POPP screening is not cost-effective to employers in most scenarios tested.

From the Department of General Medical Sciences (Dr Dale, Dr Gardner, Ms Zeringue, and Dr Evanoff), Washington University School of Medicine; School of Public Health (Ms Zeringue), St Louis University, St Louis, Mo; and Department of Environmental and Health Sciences (Dr Werner and Dr Franzblau), University of Michigan School of Public Health, Ann Arbor.

Address correspondence to: Ann Marie Dale, PhD, OTR/L, Department of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S Euclid Ave, St Louis, MO 63110 (

This study was supported by the Centers for Disease Control and Prevention–National Institute for Occupational Safety and Health (grant # R01OH008017-01) and by the Washington University Institute of Clinical and Translational Sciences Award (grant # UL1 TR000448) from the National Center for Advancing Translational Sciences of the National Institutes of Health.

The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the National Institute for Occupational Safety and Health, the National Center for Advancing Translational Sciences, the National Institutes of Health, or NeuroMetrix.

The authors declare that they have no conflicts of interest.

Copyright © 2014 by the American College of Occupational and Environmental Medicine