The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy.

Full Abstract

OBJECTIVE: The purpose of this systematic review is to evaluate current evidence in the literature on the efficacy of Semmes Weinstein monofilament examination (SWME) in diagnosing diabetic peripheral neuropathy (DPN). METHODS: The PubMed database was searched through August 2008 for articles pertaining to DPN and SWME with no language or publication date restrictions. Studies with original data comparing the diagnostic value of SWME with that of one or more other modalities for DPN in patients with diabetes mellitus were analyzed. Data were extracted by two independent investigators. Diagnostic values were calculated after classifying data by reference test, SWME methodology, and diagnostic threshold. RESULTS: Of the 764 studies identified, 30 articles were selected, involving 8365 patients. There was great variation in both the reference test and the methodology of SWME. However, current literature suggests that nerve conduction study (NCS) is the gold standard for diagnosing DPN. Four studies were identified which directly compared SWME with NCS and encompassed 1065 patients with, and 52 patients without diabetes mellitus. SWME had a sensitivity ranging from 57% (95% confidence interval [CI], 44% to 68%) to 93% (95% CI, 77% to 99%), specificity ranging from 75% (95% CI, 64% to 84%) to 100% (95% CI, 63% to 100%), positive predictive value (PPV) ranging from 84% (95% CI, 74% to 90%) to 100% (95% CI, 87% to 100%), and negative predictive value (NPV) ranging from 36% (95% CI, 29% to 43%) to 94% (95% CI, 91% to 96%). CONCLUSIONS: There is great variation in the current literature regarding the diagnostic value of SWME as a result of different methodologies. To maximize the diagnostic value of SWME, a three site test involving the plantar aspects of the great toe, the third metatarsal, and the fifth metatarsals should be used. Screening is vital in identifying DPN early, enabling earlier intervention and management to reduce the risk of ulceration and lower extremity amputation.

Author information

Author/s: Feng, Yuzhe (Y); Schlösser, Felix J (FJ); Sumpio, Bauer E (BE);

Affiliation: Section of Vascular Surgery, Yale University School of Medicine, New Haven, CT 06520, USA.

Journal and publication information

Publication Type: Journal Article; Meta-Analysis; Review

Journal: Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter (J Vasc Surg), published in United States. (Language: eng)

Reference: 2009-Sep; vol 50 (issue 3) : pp 675-82, 682.e1

Dates: Created 2009/08/24; Completed 2009/09/15;

PMID: 19595541, status: MEDLINE (last retrieval date: 9/15/2009, IMS Date: )

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