Spot CHANGE and Change Lives: The RECODE-DCM CHANGE Criteria, a Decision Support Tool to Identify Patients Requiring Urgent Investigation for Degenerative Cervical Myelopathy
Lindsay Tetreault1, Ligia Onofrei2, Noam Harel3, Shamik Bhattacharya1
1Massachusetts General Brigham, 2University of Utah, 3James J. Peters VAMC, Icahn School of Medicine at Mount Sinai
Objective:
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.
Background:
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.
Design/Methods:
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.
Results:
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.
Conclusions:
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.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.