{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T10:53:15Z","timestamp":1762253595091},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,10,26]],"date-time":"2020-10-26T00:00:00Z","timestamp":1603670400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Little is known about how different outlier estimation methods affect cutoff limits for outliers in single fiber electromyography.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We compared in a prospective fashion the established 18th jitter value (18thjv) method to three, whole\u2010distribution based, outlier detection methods: the interquartile range (IQR), the log\u2010normal, and the Z\u2010score method. The reference limits were probed in a normal cohort and in myasthenia gravis (MG) patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Differences in outlier cutoff values between the different methods were in the range of 2 \u03bcs. The number of abnormal muscles according to the computed criteria was similar for all four methods in the control group. Classification metrics (sensitivity, specificity, Youden's statistic, and predictive values) were also similar among the different methods. In the MG group, however, the Z\u2010score method failed to identify the abnormal jitter values. Accordingly, Kappa agreement was substantial to perfect (0.658 to 1) between the three methods (18thjv, IQR, and log\u2010normal), but was equivalent to chance between the three methods and the Z\u2010score in the MG group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The established 18thjv method proved largely robust when compared to whole\u2010distribution based methods, and its use in clinical practice is justified. Simple estimation of outlier limits by adding two SDs to the mean of the data, leads to unacceptable deviations from the true cutoff values. Moreover, in a clinical scenario in which the final electrodiagnosis depends only on the number of outliers, it is meaningful to accept a tolerance zone of about 2 \u03bcs, which is the approximate variation range among the different methods.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mus.27093","type":"journal-article","created":{"date-parts":[[2020,10,17]],"date-time":"2020-10-17T08:13:51Z","timestamp":1602922431000},"page":"217-224","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Identifying jitter outliers in single fiber electromyography: Comparison of four methods"],"prefix":"10.1002","volume":"63","author":[{"given":"Evangelos","family":"Anagnostou","sequence":"first","affiliation":[{"name":"Department of Neurology University of Athens, Eginition Hospital  Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Panagiota","family":"Dimopoulou","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Athens, Eginition Hospital  Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sokratis","family":"Sklavos","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Athens, Eginition Hospital  Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasiliki","family":"Zouvelou","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Athens, Eginition Hospital  Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Zambelis","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Athens, Eginition Hospital  Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,10,26]]},"reference":[{"issue":"226","key":"e_1_2_8_2_1","first-page":"1","article-title":"Human single muscle fiber action potentials","volume":"61","author":"Ekstedt J","year":"1964","journal-title":"Acta Neurol Scand"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.37.5.526"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2019.04.005"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-444-64032-1.00019-9"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.880150205"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781118736890"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.24750"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/9780470773666"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.1139"},{"key":"e_1_2_8_11_1","volume-title":"Outliers in Statistical Data","author":"Barnett V","year":"1978"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/WNP.0000000000000285"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4598(200005)23:5<715::AID-MUS8>3.0.CO;2-V"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.20568"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.10141"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.20435"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0004-282X2007000300016"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.21043"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.23710"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2011.07.044"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2012.09.028"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-58037-z"},{"key":"e_1_2_8_23_1","first-page":"387","article-title":"Repeated single fiber recordings do not affect the jitter and the fiber density","volume":"34","author":"Straube A","year":"1994","journal-title":"Electomyogr Clin Neurophysiol"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.25606"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.880170406"}],"container-title":["Muscle &amp; 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