key: cord-0990839-jrmmh972
authors: Kassardjian, Charles D.; Desai, Urvi; Narayanaswami, Pushpa
title: Reply to Letter to the Editor “The Optimal Management of Electrodiagnostic Studies during COVID‐19 Outbreak”
date: 2020-05-11
journal: Muscle Nerve
DOI: 10.1002/mus.26915
sha: 3e045119f6d629240420cb93b74d0790ee3d9654
doc_id: 990839
cord_uid: jrmmh972

nan

We thank Dr. Vinciguerra for her letter. She correctly points out that a pandemic is an evolving situation, rather than a static one, and recommendations may not apply to all time points during the pandemic. She describes an earlier pandemic scenario, which she terms the "contingency standard of care", in which there are still sufficient resources to perform electrodiagnostic studies (EDX). It is in this situation that the COVID guidance document applies most readily. 1 She also points to a second pandemic scenario, which she terms the "crisis standard of care", where medical resources, including staffing, are not available to carry out EDX studies.

Dr. Vinciguerra stratifies the availability of resources and their effect on EDX testing in her letter. We did not address resource availability in our guidance document, although it is clearly a driver of the ability to perform EDX or other testing. 1 Our intention was to provide recommendations regarding patient selection for EDX testing to clinicians during the time of the pandemic. However, in such a scenario where resources are unavailable or must be directed towards critical care, most, if not all, EDX studies may have to be postponed. Clinicians will have to rely on the clinical features and other diagnostic testing that may be available, accepting more diagnostic uncertainty before deciding on empiric treatment in acute situations such as suspected Guillain Barre syndrome or myasthenic crisis. The "possibly urgent" category in our guidance

the AANEM Quality and Patient Safety Committee of the AANEM. Practical Guidance for Managing EMG Requests and Testing during the COVID-19 Pandemic. Muscle & Nerve

document may also have to be handled similarly. 1 Resumption of EDX will depend on the subsequent availability of resources and will vary by location.