Download PDF
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2022; 80(06): 601-606
DOI: 10.1590/0004-282X-ANP-2021-0225
Article

Diagnosis of Guillain-Barré syndrome and use of Brighton criteria in Peruvian hospitals

Diagnóstico del Síndrome de Guillain-Barré y uso de los criterios de Brighton en hospitales Peruanos
Marco Malaga 
1   Universidad de San Martín de Porres, Facultad de Medicina Humana, Lima, Peru.
2   Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru.
,
Aaron Rodriguez-Calienes 
3   Universidad Científica del Sur, Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Lima, Peru.
,
Victor Velasquez-Rimachi 
2   Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru.
3   Universidad Científica del Sur, Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Lima, Peru.
,
Carlos Alva-Diaz 
4   Universidad Señor de Sipán, Chiclayo, Peru.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

ABSTRACT

Background: Guillain-Barré syndrome (GBS) is an autoimmune disease of the peripheral nervous system that caused multiple epidemiological outbreaks in Peru during 2018 and 2019. It is usually diagnosed using the Brighton criteria (BC). Objective: We aimed to determine the performance of Peruvian neurologists in diagnosing GBS based on the BC, along with its associated factors. Methods: This was a retrospective multicenter cohort study. We included patients diagnosed with GBS between 2007 and 2018 in three public hospitals in Lima, Peru. We collected data regarding demographic, clinical and management characteristics. We evaluated the use of the BC for confirmatory diagnosis of GBS and developed a logistic regression model to identify factors associated with its use. Results: Out of 328 cases, we reviewed 201 available charts. The median age was 48 years, with male predominance. Over half of the patients presented an inadequate motor examination according to their Medical Research Council (MRC) score. Additional testing included lumbar puncture and electrophysiological testing, in over 70% of the cases. The BC showed certainty level 1 in 13.4% and levels 2 and 3 in 18.3%. Neither the quality of the motor examination nor the type of institution showed any association with the BC. Conclusions: Level 1 diagnostic certainty of the BC was met in less than one quarter of the cases with a GBS diagnosis in three centers in Lima, Peru, between 2007 and 2018. This level was not significantly associated with being treated in a specialized institute, rather than in a general hospital.

Resumen

Antecedentes: El Síndrome de Guillain-Barré (SGB) es una enfermedad autoinmune del sistema nervioso periférico, causante de brotes epidemiológicos en Perú entre el 2018 y el 2019. El diagnóstico se realiza a través de los Criterios de Brighton (CB). Objetivo: Determinar el desempeño de neurólogos peruanos en diagnosticar SGB basándose en los CB, así como factores asociados. Métodos: Cohorte retrospectiva multicéntrica. Incluimos pacientes diagnosticados con SGB del 2007-2018 en 3 hospitales públicos en Lima, Perú. Recolectamos sus características demográficas, clínicas y de manejo. Evaluamos el uso de los CB para el diagnostico de SGB y empleamos un modelo de regresión logística para identificar los factores asociados con su uso. Resultados: De 328 casos, revisamos 201 historias disponibles. La edad mediana fue 48 años, con predominancia masculina. Mas del 50% de pacientes presento un examen motor inadecuado acorde con el puntaje MRC. Se realizaron exámenes auxiliares como punción lumbar y estudios electrofisiológicos en mas del 70% de pacientes. Se obtuvo un nivel de certeza 1 para los CB en un 13.4% de casos , y un nivel 2 o 3 en un 18.3%. El nivel no estuvo asociado con la calidad del examen motor ni el tipo de institución de atención. Conclusiones: Un diagnostico nivel 1 de certeza acorde con los BC se obtuvó en menos de un cuarto de casos diagnosticados como SGB. Este nivel no estuvo asociado con la atención en una institución especializada, comparado con un hospital general.

Keywords:

Guillain-Barré Syndrome - Evidence-Based Practice - Evidence-Based Medicine

Palabras clave:

Síndrome de Guillain-Barré - Práctica Clínica Basada en la Evidencia - Medicina Basada en la Evidencia

Authors’ contributions:

MM, ARC: contributed to study design, data collection, data analysis and interpretation; VVR, CAD: contributed to study design, data analysis and provided review of scientific content. All authors contributed to the writing and review of the original draft.




Publication History

Received: 10 June 2021

Accepted: 09 August 2021

Article published online:
06 February 2023

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil