The effectiveness of post-offer pre-placement nerve conduction screening for carpal tunnel syndrome.

OBJECTIVE We evaluated post-offer pre-placement (POPP) nerve conduction studies (NCS) for carpal tunnel syndrome (CTS), testing diagnostic yield and cost-effectiveness. METHODS A total of 1027 newly hired workers underwent baseline NCS and were followed for an average of 3.7 years for diagnosed CTS. Measures of diagnostic yield included sensitivity, specificity, and positive predictive value (PPV). Cost-effectiveness of POPP screening was evaluated using a range of inputs. RESULTS Abnormal NCS was strongly associated with future CTS with univariate hazard ratios ranging from 2.95 to 11.25, depending on test parameters used. Nevertheless, PPV was poor, 6.4% to 18.5%. Cost-effectiveness of POPP varied with CTS case costs, screening costs, and NCS thresholds. CONCLUSIONS Although abnormal NCS at hire increases risk of future CTS, the PPV is low, and POPP screening is not cost-effective to employers in most scenarios tested.