Diagnostic Accuracy of the Combined Bedside Tests (Icepack and Fatigability) in Diagnosing Juvenile Myasthenia Gravis.

BackgroundDiagnosing juvenile myasthenia gravis (JMG) can be challenging because of limited access to confirmatory tests.ObjectiveThis study evaluates the validity of bedside tests (the ice pack test, fatigability test, and combined bedside test) for diagnosing JMG in patients with ptosis.MethodsA retrospective analysis of children, aged 1 month to 18 years, diagnosed with ptosis who underwent bedside evaluation. We used sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and statistical analyses to compare the diagnostic performance to that of standard confirmatory tests.ResultsOf the 43 identified ptosis patients, 32 were included. The combined bedside test had a sensitivity of 92.8% and accuracy of 87.5% but modest specificity (50%). It outperformed the ice pack test (P = .0005), which showed low sensitivity (42.8%) and accuracy (43.8%). The fatigability test had 82% sensitivity and 92% PPV.ConclusionThe combined bedside test is a dependable screening instrument for JMG and may facilitate early diagnosis. The fatigability test is also a useful addition.