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Confirmatory testing is insufficiently available and expensive, so predictive examinations have value. However, few support the 2020 SFN consensus\u2010case\u2010definition requirements or were validated for non\u2010diabetes neuropathies. Thus we developed the Massachusetts General Hospital Neuropathy Exam Tool (MAGNET) and measured diagnostic performance in 160 symptomatic patients evaluated for length\u2010dependent SFN from any cause and 37 healthy volunteers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We compared prevalences of abnormalities (vital signs, pupil responses, lower\u2010limb appearance, pin, light touch, vibration and position sensitivity, great\u2010toe strength, muscle stretch reflexes), and validated diagnostic performance against objective SFN tests: lower\u2010leg skin\u2010biopsy epidermal neurite densities and autonomic function testing (AFT). Sensitivity\/specificity, feasibility, test\u2013retest and inter\u2010rater reliability, and convergence with the Utah Early Neuropathy Scale were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients\u2019 ages averaged 48.5\u2009\u00b1\u200914.7\u2009years and 70.6% were female. Causes of neuropathy varied, remaining unknown in 59.5%. Among the 46 with abnormal skin biopsies, the most prevalent abnormality was reduced pin sharpness at the toes (71.7%). Inter\u2010rater reliability, test\u2013retest reliability, and convergent validity excelled (range\u2009=\u200991.3\u201395.6%). Receiver operating characteristics comparing all symptomatic patients versus healthy controls indicated that a MAGNET threshold score of 14 maximized predictive accuracy for skin biopsies (0.74) and a 30 cut\u2010off maximized accuracy for predicting AFT (0.60). Analyzing patients with any abnormal neuropathy\u2010test results identified areas\u2010under\u2010the\u2010curves of 0.87\u20130.89 for predicting a diagnostic result, accuracy\u2009=\u20090.80\u20130.89, and Youden's index\u2009=\u20090.62. Overall, MAGNET was 80%\u201385% accurate for stratifying patients with abnormal versus normal neuropathy test results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>MAGNET quickly generates research\u2010quality metrics during clinical examinations.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mus.28013","type":"journal-article","created":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T11:38:02Z","timestamp":1702985882000},"page":"185-198","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Initial validation of the <scp>Mass. General Neuropathy Exam Tool<\/scp> (<scp>MAGNET<\/scp>) for evaluation of distal small\u2010fiber neuropathy"],"prefix":"10.1002","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1417-5349","authenticated-orcid":false,"given":"Gary R.","family":"Zirpoli","sequence":"first","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khosro","family":"Farhad","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madeleine C.","family":"Klein","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean","family":"Downs","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Max M.","family":"Klein","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9578-1596","authenticated-orcid":false,"given":"Anne Louise","family":"Oaklander","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Pathology (Neuropathology) Massachusetts General Hospital  Boston Massachusetts 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