Format

Send to:

Choose Destination
See comment in PubMed Commons below
J Neurol Sci. 2014 Aug 15;343(1-2):66-8. doi: 10.1016/j.jns.2014.05.028. Epub 2014 May 21.

Accuracy of the Babinski sign in the identification of pyramidal tract dysfunction.

Author information

  • 1Facultad de Medicina, Universidad de Antioquia, Carrera 51d N° 62-29, Medellín 050010, Colombia. Electronic address: sandraisazaneuro@yahoo.com.
  • 2Facultad de Medicina, Universidad de Antioquia, Carrera 51d N° 62-29, Medellín 050010, Colombia; Hospital Universitario San Vicente Fundación, Calle 64N° 51d-154, Medellín 050010, Colombia; Neurologic institute of Colombia, Calle 55N° 46-36, Medellín 050010, Colombia.
  • 3Facultad de Medicina, Universidad de Antioquia, Carrera 51d N° 62-29, Medellín 050010, Colombia; Hospital Universitario San Vicente Fundación, Calle 64N° 51d-154, Medellín 050010, Colombia.
  • 4Facultad de Medicina, Universidad de Antioquia, Carrera 51d N° 62-29, Medellín 050010, Colombia.
  • 5Neurologic institute of Colombia, Calle 55N° 46-36, Medellín 050010, Colombia.
  • 6Methodist Neurological Institute, 6560 Fannin Street, Suite 802, Houston, TX 77030, USA.

Abstract

BACKGROUND:

The extensor plantar response described by Joseph Babinski (1896) indicates pyramidal tract dysfunction (PTD) but has significant inter-observer variability and inconsistent accuracy. The goal of this study was to determine the accuracy of the Babinski sign in subjects with verified PTD.

METHODS:

We studied 107 adult hospitalized and outpatient subjects evaluated by neurology. The reference standard was the blinded and independent diagnosis of an expert neurologist based on anamnesis, physical examination, imaging and complementary tests. Two neurologists elicited the Babinski sign in each patient independently, blindly and in a standardized manner to measure inter-observer variability; each examination was filmed to quantify intra-observer variability.

RESULTS:

Compared with the reference standard, the Babinski sign had low sensitivity (50.8%, 95%CI 41.5-60.1) but high specificity (99%, 95%CI 97.7-100) in identifying PTD with a positive likelihood ratio of 51.8 (95%CI 16.6-161.2) and a calculated inter-observer variability of 0.73 (95%CI 0.598-0.858). The intraevaluator reliability was 0.571 (95%CI 0.270-0.873) and 0.467 (95%, CI 0.019-0.914) respectively, for each examiner.

CONCLUSION:

The presence of the Babinski sign obtained by a neurologist provides valid and reliable evidence of PTD; due to its low sensitivity, absence of the Babinski sign still requires additional patient evaluation if PTD is suspected.

Copyright © 2014 Elsevier B.V. All rights reserved.

KEYWORDS:

Accuracy; Babinski sign; ROC curve; Sensitivity; Specificity

PMID:
24906707
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk