A critique of a UK standardized test of finger rewarming after cold provocation in the diagnosis and staging of hand-arm vibration syndrome

Mason, Howard, Poole, Kerry and Saxton, John (2003) A critique of a UK standardized test of finger rewarming after cold provocation in the diagnosis and staging of hand-arm vibration syndrome. Occupational Medicine, 53 (5). pp. 325-30. ISSN 0962-7480

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Official URL: http://dx.doi.org/10.1093/occmed/kqg096


Background - Accurate diagnosis and staging of hand-arm vibration syndrome (HAVS) is important in health surveillance of vibration-exposed workers and the substantial number of related medico-legal cases. The measurement of the rewarming rate of fingers after cold provocation to the hands (CPT) has been suggested as a useful test in diagnosing HAVS.

Aim - To investigate the diagnostic value of a standardized version of the CPT test using a 15 degrees C cold challenge for 5 min applied in the recent compensation assessment of UK miners.

Methods - Analysis of a subset of UK miners assessed at our unit, together with data from a small repeatability study of the standardized CPT in normal subjects.

Results - Rewarming time in the CPT was significantly lower in those subjects classified as vascular Stockholm stage 0 compared with Stockholm stages 1-3 combined, but did not discriminate between the stages of abnormality. Using the suggested cut-off in the CPT test, the sensitivity and specificity were calculated as 43 and 78%, respectively. Receiver operator characteristic analysis suggested that the rewarming time of highest accuracy gave a sensitivity of 66% and specificity of 59%. In 10 miners who reported unilateral hand blanching, there was no significant difference in CPT measurements between blanching and non-blanching hands. Repeat CPT measurements in normal subjects suggested mean differences of 52 and 107 s for each hand, and the Bland-Altman coefficient of repeatability was approximately 600 s for all fingers.

Conclusion - Single application of this standardized CPT test may have limited value in diagnosing the vascular component of HAVS in an individual.

Item Type: Article
Uncontrolled Keywords: HAVS, vibration‐induced Raynaud's phenomenon, vibration white finger
Subjects: B100 Anatomy, Physiology and Pathology
Department: Faculties > Health and Life Sciences > Sport, Exercise and Rehabilitation
Depositing User: Prof John Saxton
Date Deposited: 01 Mar 2016 14:53
Last Modified: 12 Oct 2019 15:28
URI: http://nrl.northumbria.ac.uk/id/eprint/26257

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