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Abstract Details

Spot CHANGE and Change Lives: The RECODE-DCM CHANGE Criteria, a Decision Support Tool to Identify Patients Requiring Urgent Investigation for Degenerative Cervical Myelopathy
Neuromuscular and Clinical Neurophysiology (EMG)
P6 - Poster Session 6 (5:00 PM-6:00 PM)
9-001

The primary objectives of this study were to (i) develop pragmatic, evidence-based criteria to help frontline healthcare providers identify patients at risk for degenerative cervical myelopathy (DCM) and (ii) define key clinical scenarios in which the application of the screening criteria would be most appropriate.
The diagnosis of DCM is often delayed, resulting in significant consequences such as the development of permanent or more severe neurological impairment, incomplete or suboptimal postoperative recovery and increased dependence on caregivers.
A three-step process was employed. First, two systematic reviews were conducted to determine the frequency and diagnostic accuracy of DCM-related symptoms and signs. Second, an international survey was distributed to a multidisciplinary group of healthcare providers asking them to rank 39 symptoms and 34 signs in terms of their importance for diagnosing DCM. Finally, an Expert Working Group including multidisciplinary specialists engaged in a structured consensus process to refine and rank candidate criteria. The group also identified key clinical scenarios for application through discussion.
Following consensus discussions, the top four symptoms and four signs were consolidated into six core criteria: Clumsy or weak hands, Hoffmann or Tromner sign, Ataxia or imbalance, Numb or tingling hands, Gait abnormalities, and Exaggerated reflexes, forming the mnemonic “CHANGE.” The group recommended applying these criteria to any patient with motor or sensory complaints of the extremities, gait dysfunction, suspected carpal tunnel syndrome, neck pain with or without cervical radiculopathy, lumbar radiculopathy or spinal stenosis, recurrent falls, and incidental cervical cord compression on MRI.
The CHANGE criteria integrate common symptoms and easily elicited signs of DCM into a simple mnemonic to support early recognition by non-specialists. By prompting targeted neurological assessment, this tool aims to reduce diagnostic delays and expedite surgical referral when indicated. Spotting CHANGE will change lives.
Authors/Disclosures
Lindsay Tetreault, MD, PhD
PRESENTER 		Dr. Tetreault has nothing to disclose.
Ligia V. Onofrei, MD Dr. Onofrei has nothing to disclose.
Noam Harel, MD, PhD (James J. Peters VAMC, Icahn School of Medicine at Mount Sinai) Dr. Harel has received personal compensation for serving as an employee of James J. Peters VA Medical Center. Dr. Harel has received personal compensation for serving as an employee of Icahn School of Medicine at Mount Sinai. Dr. Harel has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for RubiconMD. Dr. Harel has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Dalton & Finegold, LLP. The institution of Dr. Harel has received research support from NIH. The institution of Dr. Harel has received research support from Craig H. Neilsen Foundation. The institution of Dr. Harel has received research support from New York State Department of Health. The institution of Dr. Harel has received research support from VA Rehabilitation Research and Development. Dr. Harel has a non-compensated relationship as a Neurology Editorial Board Member with AAN that is relevant to AAN interests or activities. Dr. Harel has a non-compensated relationship as a Member, Board of Directors with American Society of Neurorehabilitation that is relevant to AAN interests or activities. Dr. Harel has a non-compensated relationship as a Chair, AAN Spine Section with AAN that is relevant to AAN interests or activities.
Shamik Bhattacharyya, MD, FAAN (Brigham and Women's Hospital) Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NeuroLambda. Dr. Bhattacharyya has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Bhattacharyya has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum. Dr. Bhattacharyya has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley. Dr. Bhattacharyya has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Merck. The institution of Dr. Bhattacharyya has received research support from Alexion Pharmaceuticals. The institution of Dr. Bhattacharyya has received research support from National Institute of Health. The institution of Dr. Bhattacharyya has received research support from UCB. The institution of Dr. Bhattacharyya has received research support from Genentech. Dr. Bhattacharyya has received publishing royalties from a publication relating to health care. Dr. Bhattacharyya has received publishing royalties from a publication relating to health care.