Diagnostic Accuracy of Point-of-care Tests Used to Detect Arterial Disease in Diabetes

Normahani, Pasha; Poushpas, Sepideh; Alaa, Mays; Bravis, Vassiliki; Sounderajah, Viknesh; Aslam, Mohammed; Jaffer, Usman

doi:10.1097/sla.0000000000004545

Cited by 14 publications

(60 citation statements)

References 30 publications

(42 reference statements)

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“…Six studies investigated the TBI as an index test for PAD (with cut-off values of below 0·70 and 0·75). 36 , 37 , 39 , 40 , 45 , 47 In these studies, PLRs ranged from 1·62 to 4·26. NLRs fluctuated between 0 and 0·47.…”

Section: Resultsmentioning

confidence: 89%

“… Threshold of reference test to diagnose PAD was unclear. *Normahani et al 39 2020 United Kingdom Multicenter prospective cohort study N = 305 patients with diabetes (recruited from diabetic foot clinics) Mean age: 72 years Gender: 68% male Mean duration of DM was 17 years CKD was present in 17% of patients Pulse palpation (absence of dorsalis pedis or posterior tibial artery pulse) Audible Doppler (monophasic or absent signal in either vessel) Visual Doppler with handheld Doppler device (monophasic or absent signal in either vessel) ABI < 0.9 TBI < 0.75 TcPO2 <40 mmHg PAD-scan (the presence of an occlusion, venous like slow flow, monophasic waveform or a biphasic waveform with adverse features in either vessel) DUS (PAD was defined as >50% stenosis) ABI Sens: 60% Spec: 75% PLR: 2.46 NLR: 0.53 Audible Doppler Sens: 74% Spec: 76% PLR: 3.04 NLR: 0.35 Visual Doppler Sens: 83% Spec: 75% PLR: 3.28 NLR: 0.23 Pulse palpation Sens: 43% Spec: 81% PLR: 2.22 NLR: 0.71 TBI Sens: 60% Spec: 86% PLR: 4.26 NLR: 0.47 TcPO2 Sens: 31% Spec: 79% PLR: 1.43 NLR: 0.88 PAD-scan Sens: 95% Spec: 77% PLR: 4.06 NLR: 0.07 PAD-scan was performed using a portable ultrasound machine with a linear 6-14Hz transducer. A ‘normal’ biphasic waveform indicated no PAD.…”

Section: Resultsmentioning

confidence: 99%

“…The results of the quality assessment are illustrated in Table 3 . Only three 29 , 36 , 39 of the included studies were of high methodological quality (i.e. low risk of bias in all domains assessed).…”

Section: Resultsmentioning

confidence: 99%

“…Eighteen studies evaluated the ABI to diagnose PAD in patients prone to MAC. 28 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 In these studies, 10 different variables were investigated ( Table 4 shows an overview). In studies including patients with an ABI >1·3, the PLR ranged between 1·22 and 17, and the NLR ranged between 0 and 0·69 for an ABI with a threshold of <0·90.…”

Section: Resultsmentioning

confidence: 99%

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Reliability of bedside tests for diagnosing peripheral arterial disease in patients prone to medial arterial calcification: A systematic review

et al. 2022

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Section: Resultsmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Reliability of bedside tests for diagnosing peripheral arterial disease in patients prone to medial arterial calcification: A systematic review

et al. 2022

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“…anklebrachial pressure index (ABPI), toe-brachial pressure index (TBPI), transcutaneous pressure of oxygen (TcPO2)), it has been demonstrated that visually displayed Doppler arterial waveforms at the ankle may be the best test for excluding PAD in patients with diabetes. 5 A haemodynamically significant arterial lesion results in a change in the downstream waveform morphology.…”

Section: Physical Examinationmentioning

confidence: 99%

Diabetic foot disease

Normahani¹,

Shalhoub²

2022

Surgery (Oxford)

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Diabetic foot disease, or ulceration, is prevalent and is associated with high rates of lower limb amputation and mortality. Its underlying aetiology is complex and multifactorial. However, neuropathy and peripheral arterial disease represent two important precipitating risk factors. Regular, comprehensive foot examinations are important in the prevention of ulceration and cardiovascular complications as they provide an opportunity to assess risk, modify risk factors and deliver patient education. Charcot neuropathic osteoarthropathy is commonly misdiagnosed and should always be suspected in an individual with diabetes presenting with a hot and swollen foot. Diabetic foot ulcers are challenging to manage. The key to optimizing outcomes includes early diagnosis with referral for coordinated multidisciplinary care where prompt treatment of infection and peripheral arterial disease, as well as appropriate wound care and offloading can be initiated and monitored.

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Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review

Chuter

Schaper

Mills

et al. 2023

Diabetes Metabolism Res

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As a progressive disease process, early diagnosis and ongoing monitoring and treatment of lower limb peripheral artery disease (PAD) is critical to reduce the risk of diabetes‐related foot ulcer (DFU) development, non‐healing of wounds, infection and amputation, in addition to cardiovascular complications. There are a variety of non‐invasive tests available to diagnose PAD at the bedside, but there is no consensus as to the most diagnostically accurate of these bedside investigations or their reliability for use as a method of ongoing monitoring. Therefore, the aim of this systematic review was to first determine the diagnostic accuracy of non‐invasive bedside tests for identifying PAD compared to an imaging reference test and second to determine the intra‐ and inter‐rater reliability of non‐invasive bedside tests in adults with diabetes. A database search of Medline and Embase was conducted from 1980 to 30 November 2022. Prospective and retrospective investigations of the diagnostic accuracy of bedside testing in people with diabetes using an imaging reference standard and reliability studies of bedside testing techniques conducted in people with diabetes were eligible. Included studies of diagnostic accuracy were required to report adequate data to calculate the positive likelihood ratio (PLR) and negative likelihood ratio (NLR) which were the primary endpoints. The quality appraisal was conducted using the Quality Assessment of Diagnostic Accuracy Studies and Quality Appraisal of Reliability quality appraisal tools. From a total of 8517 abstracts retrieved, 40 studies met the inclusion criteria for the diagnostic accuracy component of the review and seven studies met the inclusion criteria for the reliability component of the review. Most studies investigated the diagnostic accuracy of ankle ‐brachial index (ABI) (N = 38). In people with and without DFU, PLRs ranged from 1.69 to 19.9 and NLRs from 0.29 to 0.84 indicating an ABI <0.9 increases the likelihood of disease (but the extent of the increase ranges from a small to large amount) and an ABI within the normal range (≥0.90 and <1.3) does not exclude PAD. For toe‐brachial index (TBI), a threshold of <0.70 has a moderate ability to rule PAD in and out; however, this is based on limited evidence. Similarly, a small number of studies indicate that one or more monophasic Doppler waveforms in the pedal arteries is associated with the presence of PAD, whereas tri‐ or biphasic waveform suggests that PAD is less likely. Several forms of bedside testing may also be useful as adjunct tests and 7 studies were identified that investigated the reliability of bedside tests including ABI, toe pressure, TBI, transcutaneous oxygen pressure (TcPO2) and pulse palpation. Inter‐rater reliability was poor for pulse palpation and moderate for TcPO2. The ABI, toe pressure and TBI may have good inter‐ and intra‐rater reliability, but margins of error are wide, requiring a large change in the measurement for it to be considered a true change rather than error. There is currently no single bedside test or a combination of bedside tests that has been shown to have superior diagnostic accuracy for PAD in people with diabetes with or without DFU. However, an ABI <0.9 or >1.3, TBI of <0.70, and absent or monophasic pedal Doppler waveforms are useful to identify the presence of disease. The ability of the tests to exclude disease is variable and although reliability may be acceptable, evidence of error in the measurements means test results that are within normal limits should be considered with caution and in the context of other vascular assessment findings (e.g., pedal pulse palpation and clinical signs) and progress of DFU healing.

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Diagnostic Accuracy of Point-of-care Tests Used to Detect Arterial Disease in Diabetes

Cited by 14 publications

References 30 publications

Reliability of bedside tests for diagnosing peripheral arterial disease in patients prone to medial arterial calcification: A systematic review

Reliability of bedside tests for diagnosing peripheral arterial disease in patients prone to medial arterial calcification: A systematic review

Diabetic foot disease

Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review

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