Fluoroscopic sniff test as a diagnostic tool for phrenic nerve injury in patients with traumatic brachial plexus injury
1
Issued Date
2024-11-01
Resource Type
eISSN
19330693
Scopus ID
2-s2.0-85208452964
Pubmed ID
38848606
Journal Title
Journal of neurosurgery
Volume
141
Issue
5
Start Page
1363
End Page
1368
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of neurosurgery Vol.141 No.5 (2024) , 1363-1368
Suggested Citation
Watanapokasin P., Monteerarat Y., Ongsiriporn M., Limthongthang R., Vathana T., Laohaprasitiporn P. Fluoroscopic sniff test as a diagnostic tool for phrenic nerve injury in patients with traumatic brachial plexus injury. Journal of neurosurgery Vol.141 No.5 (2024) , 1363-1368. 1368. doi:10.3171/2024.3.JNS232879 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/102012
Title
Fluoroscopic sniff test as a diagnostic tool for phrenic nerve injury in patients with traumatic brachial plexus injury
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Abstract
OBJECTIVE: Traumatic brachial plexus injury (BPI) is a high-morbidity condition with an escalating incidence. One of the treatment options is neurotization using the ipsilateral phrenic nerve. Therefore, diagnosis of nerve dysfunction is a crucial step in preoperative planning. This study aimed to assess the accuracy and reliability of the fluoroscopic sniff test for preoperative diagnosis of phrenic nerve injury in patients with traumatic BPI. METHODS: The study was conducted from June 2019 to August 2023 at a tertiary care hospital. A preoperative fluoroscopic sniff test was performed. During brachial plexus surgery, direct phrenic nerve stimulation was conducted as a gold standard of phrenic nerve function. Two nonoperating orthopedic surgeons interpreted the accuracy and reliability of the test. RESULTS: Seventy-four patients with traumatic BPI (66 males and 8 females) with a median age of 26 years were enrolled. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the fluoroscopic sniff test were 90.9% (95% CI 75.7%-98.1%), 100% (95% CI 91.4%-100%), 100% (95% CI 88.4%-100%), 93.2% (95% CI 82.3%-97.6%), and 95.9% (95% CI 88.6%-99.2%), respectively. Interobserver reliability showed excellent agreement (κ = 1, p < 0.001). CONCLUSIONS: The fluoroscopic sniff test was proven to be an accurate, reliable, and simple tool to evaluate phrenic nerve function in patients with traumatic BPI. Preoperative testing should be performed to reduce operative time to identify the phrenic nerve as a donor for nerve transfer surgery in cases in which no function is detected from the fluoroscopic sniff test.