Comparison of Peak Versus Onset Latency Measurements in Electrodiagnostic Tests for Carpal Tunnel Syndrome

Purpose: The aim of this prospectively conducted study was to compare the diagnostic accuracy of onset versus peak latency measurements of sensory nerve action potentials in electrodiagnostic studies in diagnosing carpal tunnel syndrome. Methods: In 156 consecutive patients with clinically defined carpal tunnel syndrome, standardized nerve conduction studies (DIG1, DIG4, PALM3) were performed. Both onset and peak latency were measured. Sensitivity was calculated using the clinical diagnosis as golden standard. Bland-Altman plots were constructed to assess the agreement for quantitative measurements. Overall agreement, positive and negative percent agreement, and Kappa coefficient were computed. Results: The Bland-Altman plots, positive and negative percent agreement show good overall agreement. The kappa coefficient was 0.850, 0.847, and 0.815 for DIG1, DIG4, and PALM3, respectively. Conclusions: Onset and peak latencies used in electrodiagnostic tests show a good overall agreement in confirming the clinical diagnosis of carpal tunnel syndrome. Because onset latency measurement represents nerve conduction velocity of the fastest conducting fibers, the use of onset latencies is recommend. In case of uncontrollable stimulus artifacts, peak latencies may be used instead.