• diagnosis;
  • ice pack test;
  • ice test;
  • myasthenia gravis;
  • neuromuscular disease;
  • ptosis


Introduction: Several studies have reported high diagnostic sensitivity and specificity for the ice test in myasthenia gravis. All of the studies employed a case–control design, in which the diagnosis was already known at the time of the test for both patients and controls, leading to case selection bias. This suggests that the available literature substantially overestimates the diagnostic utility of these tests. Methods: A retrospective cohort study without selection bias was performed to examine the sensitivity and specificity of the ice test. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the ice test were determined by means of a 2 × 2 table. Results: The ice test has a sensitivity of 0.92 (95% CI 0.62–1.00), specificity of 0.79 (95% CI 0.56–1.00), PPV of 0.73 (95% CI 0.48–0.90), and NPV of 0.94 (95% CI 0.70–1.00). Conclusions: Due to its high negative predictive value the ice test is still a reliable and useful bed-side test. Muscle Nerve 48: 902–904, 2013