AWAJI criteria are not always superior to the previous criteria: A meta-analysis

Muscle Nerve. 2015 Jun;51(6):822-9. doi: 10.1002/mus.24575. Epub 2015 Mar 31.


Introduction: Recently, some authors have claimed that the Awaji criteria (AC) are not always more sensitive than the revised El Escorial criteria (rEEC) in amyotrophic lateral sclerosis (ALS).

Methods: A meta-analysis examined 2 prospective and 7 retrospective studies, which included 1,121 ALS patients, to compare AC and rEEC for early diagnosis of ALS.

Results: AC led to an 11% greater likelihood of being classified into the categories "clinically definite" or "clinically probable", while if confined to the "clinically probable - laboratory supported (LS)" category, this effect was 40% higher with the rEEC (95% cnfidence interval, 3-82%; I2=98%). Specifically, AC downgraded 20% of the rEEC "clinically probable - LS" category to the AC "clinically possible".

Conclusions: Despite overall superiority of AC, this meta-analysis shows that it is not always more sensitive than rEEC. These results are related to the requirement for 2 upper motor neuron signs in the AC "clinically probable" category.

Keywords: ALS; Awaji criteria; amyotrophic lateral sclerosis; diagnostic criteria; revised El Esocorial criteria; sensitivity.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Amyotrophic Lateral Sclerosis / diagnosis*
  • Amyotrophic Lateral Sclerosis / epidemiology
  • Databases, Bibliographic / statistics & numerical data
  • Demography
  • Early Diagnosis
  • Electromyography
  • Humans
  • ROC Curve