Título:	Avaliação da acurácia do teste de força- duração na triagem eletrodiagnóstica da polineuropatia da doença crítica
Autor(es):	Macedo, José Roberto de Deus
Orientador(es):	Martins, Emerson Fachin
Assunto:	Cronaxia Cuidados críticos Testes diagnósticos
Data de publicação:	26-Jun-2026
Data de defesa:	8-Jan-2025
Referência:	MACEDO, José Roberto de Deus. Avaliação da acurácia do teste de força- duração na triagem eletrodiagnóstica da polineuropatia da doença crítica. 2025. 154 f. il. Tese (Doutorado em Ciências e Tecnologias em Saúde) — Universidade de Brasília, Brasília, 2025.
Abstract:	Introduction: Critical illness polyneuropathy (CIPN), frequently associated with critical illness myopathy (CIM), are the two main causes of acquired muscle weakness in the ICU, hence the term critical illness polyneuromyopathy (CIPNM). Early diagnosis and management of this axonopathy are fundamental for improving functionality and quality of life. Electroneuromyography (ENMG) is considered the main examination to identify this neuromyopathy, but it has intrinsic limitations and operational difficulties. The Strength Duration Test (SDT) and the Stimulus Electrodiagnostic Test (SET) present themselves as non invasive electrodiagnostic screening alternatives in the ICU, with lower cost and greater feasibility. However, their diagnostic metrics and thresholds have not yet been properly explored in the ICU. Objective: To analyze the accuracy and diagnostic metrics of the SDT and SET for screening CIPNM in the ICU; to evaluate the presence and clinical relevance of electrodiagnostic asymmetry in the application of the tests; and the possibility of automating these electrodiagnostic tools. Method: Prospective cross-sectional studies were conducted involving critically ill adult patients on mechanical ventilation for ≥72 hours in the ICU. Participants underwent bilateral Simplified Electrophysiological Testing of the Peroneal Nerve (PENT) – the reference test, followed by SDT and SET – index tests. The results were analyzed for a comprehensive description of their diagnostic metrics, and the relevance of electrodiagnostic asymmetry was verified by bilateral PENT measurements. The fourth manuscript evaluated the automation of SDT and SET. Results: Appropriate thresholds and diagnostic metrics for SDT and SET of the peroneal nerve in critically ill patients with axonopathy were established, respectively: SDT’s sensitivity of 73% (62-85%), specificity of 68% (53-81%), accuracy of 71% (62-81%), and area under Roc curve (AUC) of 0.8 (95% CI: 0.7–0.8, p<0.001), with an optimal cutoff point of 600 mC (Youden test); SET’s sensitivity of 89% (79-85%), 42% (28-58%) specificity, 71% (62-75%) accuracy, and AUC of 0.7 (95% CI: 0.59–0.81, p=0.001), with an optimal chronaxie cutoff of 1.8 ms. These diagnostic metrics were slightly more favorable for SDT. Both tests can be safely automated. Asymmetries were observed in 12 (29%) participants, more significant for the group with PNMDC (attributed risk of 17% (-30 to 64%)), with diagnostic divergence in 5 (12%) patients, in whom PNMDC could go unnoticed if the assessment were unilateral, probably associated with laterality and/or focal lesions of the central nervous system (CNS). Conclusion: SDT and TEDE represent promising alternatives for the early diagnostic screening of CIPNM in the ICU, with the automated version being equally reliable. Electrodiagnostic assessments should be performed bilaterally, minimizing the risk of false negatives due to the clinical relevance of electrodiagnostic asymmetry. Further prospective cohort studies with larger samples and greater patient diversity should be conducted to reproduce and better validate these results.
Unidade Acadêmica:	Faculdade de Ciências e Tecnologias em Saúde (FCTS) – Campus UnB Ceilândia
Informações adicionais:	Tese (doutorado) — Universidade de Brasília, Faculdade de Ceilândia, Programa de Pós-graduação em Ciências e Tecnologias em Saúde, 2025.
Programa de pós-graduação:	Programa de Pós-Graduação em Ciências e Tecnologias em Saúde
Aparece nas coleções:	Teses, dissertações e produtos pós-doutorado

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