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Strategies for analyzing nerve conduction data: Superiority of a summary index over single tests

We compared three strategies for diagnosing carpal tunnel syndrome: using a single test; requiring one, two, or three of three tests to be abnormal; or utilizing a single summary variable incorporating data from three tests. Sixty‐five hands of subjects without clinical carpal tunnel syndrome (CTS) were compared with 66 hands with clinical CTS. Three latency differences were measured: median‐ulnar (8 cm) midpalmar orthodromic (palmdiff); median‐ulnar ring finger (14 cm) antidromic (ringdiff); and median‐radial thumb (10 cm) antidromic (thumbdiff). The combined sensory index (CSI) was the sum of these three differences. Sensitivity for the tests was palmdiff 69.7%, ringdiff 74.2%, thumbdiff 75.8%, and CSI 83.1%. Specificity was 95.4–96.9%. Requiring one, two, or three of three tests to be abnormal yielded sensitivities of 84.8%, 74.2%, or 56.1%, respectively, but specificities of 92.3%, 98.5%, and 100%, respectively. We conclude that a combined index improves diagnostic classification over use of single test results. © 1998 John Wiley & Sons, Inc. Muscle Nerve 21: 1166–1171, 1998.