J Korean Med Sci.  2011 Apr;26(4):568-573. 10.3346/jkms.2011.26.4.568.

Proposing a Scoring System for the Research Criteria of Complex Regional Pain Syndrome

• Yim KH
• Park SY
• Yim JY
• Kim YC
• Lee SC
• Nahm FS

• KMID: 1777889
• DOI: http://doi.org/10.3346/jkms.2011.26.4.568

Abstract

This study evaluated the structure of complex regional pain syndrome (CRPS) population and suggested a weighted scoring system to balance on objective signs. One hundred sixty-eight consecutive patients were evaluated using the Budapest Research Criteria (BRC). By using multidimensional scaling and logistic regression analysis, we analyzed the degree of importance and relationships between objective findings. In addition, a receiver operating characteristic curve was constructed using a weighted score derived from the risk ratio as a diagnostic test. There were correlations between skin color change and edema, and between decreased range of motion and motor dysfunction when multidimensional scaling was applied. The trophic change was excluded by a logistic regression (95% CI; 0.80-11.850). The cutoff point based on weighted score derived from the risk ratios for determining CRPS was 7.88. At this point, the sensitivity, specificity, positive predictive value and negative predictive value were 75.0%, 95.3%, 96.3%, and 70.1%, respectively. We propose a weighted scoring system for the BRC using risk ratios of objective signs. Although a thorough systematic review would be required in the future, this study can contribute to reduction of the possible distortion of the feature of CRPS populations by the BRC.

Keyword

Complex Regional Pain Syndrome; Diagnosis; Objective Sign; Odds Ratio; Score

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Complex Regional Pain Syndromes/*diagnosis/etiology
Diagnosis, Differential
Female
Humans
Logistic Models
Male
Middle Aged
Odds Ratio
Predictive Value of Tests
ROC Curve
Risk Factors
*Severity of Illness Index

Figure

• 

  Fig. 1 Two-dimensional representation of the relationship between seven objective items from the sample of 104 patients with CRPS. Multidimensional scaling analysis shows 2 tight links between edema and skin color, and between sensory and com-RM. The S-Stress is 0.107 and the R-squared index is 0.923 as a goodness-of-fit measure. Com-RM, combined form of decreased range of motion and motor dysfunction.

• 

  Fig. 2 Receiver operating characteristic (ROC) curve for diagnostic criteria of CRPS for research. The area under the ROC curve measures the performance of the test (0.931) and the best cutoff score was 7.88. The 45° dotted line represents the point at which the test is no better than chance.

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