Pulse Oximetry as a Potential Screening Tool for Lower Extremity Arterial Disease in Asymptomatic Patients With Diabetes Mellitus

Parameswaran, G. Iyer; Brand, Kerstin; Dolan, James P.

doi:10.1016/j.accreview.2005.04.021

Cited by 6 publications

(8 citation statements)

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“…Optimal recordings are obtained with blood pressure cuffs that are appropriately sized to the patient's lower calf (immediately above the ankle), and systolic pressures are recorded with a handheld Doppler instrument 16,17,19,[20][21][22][23] or oscillometric method. 18 Since ankle arterial pressures are normally greater than 90% of the brachial arterial pressure, an ABI ≤ 0.90 has been used in the diagnosis of PAD.…”

Section: Discussionmentioning

confidence: 99%

“…16 Noninvasive and easy methods of detecting PAD were preferred in clinical practice, so an imaging diagnostic technology was often used in many of the studies as a standard reference in defining serious luminal stenosis for the diagnosis of PAD. Studies were eligible if the sensitivity and specificity of ABI ≤ 0.90 for stenosis ≥ 50% in peripheral arteries were clearly reported by comparison with a standard reference such as DSA, 17,18 WBMRA, 19 DWA, 20 CDI, 21 CDU, 16,22 and arteriography. 23 Additionally, relevant references cited within identified publications were reviewed.…”

Section: Search Strategy and Selection Criteriamentioning

confidence: 99%

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Sensitivity and specificity of the ankle—brachial index to diagnose peripheral artery disease: a structured review

et al. 2010

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The ankle-brachial index (ABI) is a simple, inexpensive diagnostic test for peripheral artery disease (PAD). However, it has shown variable accuracy for identification of significant stenosis. The authors performed a structured review of the sensitivity and specificity of ABI ≤ 0.90 for the diagnosis of PAD. MEDLINE, EMBASE, Cochrane databases, Science Citation Index database, and Biological Abstracts database were searched for studies of the sensitivity and specificity of using ABI ≤ 0.90 for the diagnosis of PAD. Eight studies comprising 2043 patients (or limbs) met the inclusion criteria. The result indicated that, although strict inclusion criteria on studies were formulated, different reference standards were found in these studies, and methods of ABI determination and characteristics of populations varied greatly. A high level of specificity (83.3-99.0%) and accuracy (72.1-89.2%) was reported for an ABI ≤ 0.90 in detecting ≥ 50% stenosis, but there were different levels of sensitivity (15-79%). Sensitivity was low, especially in elderly individuals and patients with diabetes. In conclusion, the test of ABI ≤ 0.90 can be a simple and useful tool to identify PAD with serious stenosis, and may be substituted for other non-invasive tests in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Search Strategy and Selection Criteriamentioning

confidence: 99%

Sensitivity and specificity of the ankle—brachial index to diagnose peripheral artery disease: a structured review

et al. 2010

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“…15 Reports indicate that 31% of the diabetic patients have peripheral arterial disease in lower extremity arteries by dUSG even in asymptomatic patients. 16 Annual screening for peripheral arterial disease is recommended for patients with diabetes mellitus and for those older than 40 years. 17 In our study, dUSG revealed a pathological finding in 39.5% of the patients.…”

Section: Discussionmentioning

confidence: 99%

Diabetic Foot Infections and the Role of Doppler USG in Prognosis

Tunçcan¹,

Dizbay²,

Hızel³

et al. 2012

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : To determine the value of patient characteristics, laboratory parameters, and imaging procedures in the assessment of the severity and prognosis of diabetic foot infections (DFIs). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Demographic and clinical characteristics of 71 patients with DFI were evaluated retrospectively. Patient characteristics and clinical data including diabetes status and wound related information, laboratory and radiologic findings, and outcomes were recorded. R Re es su ul lt ts s: : In patients between 35 and 60 years old, the frequency of recurrent diabetic foot infections were four and half-times higher than in those over 60 years (OR 4.55, 95% CI 1.50-13.83, p= 0.007). The white blood cell count was significantly higher in severe infections (p<0.05). Gram negative microorganisms were predominantly isolated from the wound cultures of patients aged between 35 and 65 years (p= 0.04). Pathological findings in Doppler Ultrasonography (dUSG) was correlated with smoking (p= 0.004). There was no significant association between the severity of the wound and pathological findings in dUSG. However, presence of a pathological finding in dUSG was correlated with amputation (p=0.001). Moreover, the probability of poor outcome was four-fold higher in patients with a pathology in dUSG in the logistic regression analysis (OR 4.32, 95% CI, 1.24-14.97, p= 0.025). C Co on nc cl lu us si io on n: : In the management of empirical therapy, gram negative microorganisms should be considered, especially in patients of 35-65 years of age. Pathological findings in dUSG were found to be related to poor outcome such as amputation. Therefore, all patients with diabetic foot should be screened with dUSG to identify those at risk for amputation.K Ke ey y W Wo or rd ds s: : Diabetic foot; risk factors; prognosis; ultrasonography, doppler Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmada, diyabetik ayak enfeksiyonlarında klinik, laboratuvar ve radyolojik bulguların enfeksiyon şiddetine ve prognozuna etkisi değerlendirilmiştir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Diyabetik ayak enfeksiyonu olan 71 hasta retrospektif olarak incelenmiştir. Hastaların özellikleri, diyabet ve diyabetik ayak yarası ile ilgili bilgileri, laboratuvar ve radyolojik bulguları ve prognozları değerlendirilmiştir. B Bu ul lg gu ul la ar r: : Hastalarda tekrarlayan lezyon gelişme sıklığının, 35-60 yaş arası hasta grubunda, >60 yaş hasta grubuna göre yaklaşık 4.5 kat fazla olduğu saptanmıştır [Odds Oranı (OO) 4.55, %95 GA 1,50-13,83, p= 0,007]. Şiddetli enfeksiyon ile lökositoz arasında anlamlı bir ilişki saptanmıştır (p< 0,05). Yaşları 35-65 arasında olan hastaların yara yeri kültürlerinde gram negatif mikroorganizlar daha sık izole edilmiştir (p=0,04). Sigara kullanma ile Doppler ultrasonografi (USG) incelemesinde patoloji olması arasında anlamlı bir ilişki bulunmuştur (p= 0,004). Doppler USG'de patoloji ile yaranın ciddiyeti arasında herhangi bir ilişki gözlenmemiştir. ...

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“…Screening ABI every 5 years in patients with diabetes without any signs/symptoms of vascular insufficiency has been recommended. Pulse oximetry has also been reported to be as effective as ABI and the sensitivity of the test will be improved if used together with ABI [53]. The transcutaneous oxygen tension method is a reliable indicator of skin perfusion as periwound cutaneous perfusion is the critical physiological determinant of ulcer healing.…”

Section: Other Investigationsmentioning

confidence: 99%

Diabetic Foot Ulcer – Diagnosis and Management

Pai¹

2013

Clin Res Foot Ankle

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Diabetes Mellitus is known to have many complications and one of the most distressing is diabetic foot ulcer which affects 15% of people with diabetes. It puts enormous financial burden on the patient and the health care services, even though it is preventable. Diabetic foot ulcer is characterized by a classical triad of neuropathy, ischemia, and infection. Each of these has a multifactorial aetiopathogenesis. These factors are compounded by mechanical stress created by foot deformities. The most commonly used classification systems are the Wagner-Ulcer Classification system and the University of Texas Wound Classification. These classifications help to predict the outcome of this condition. Prevention of this condition is paramount to prevent long term morbidity and sometimes mortality. This can be achieved by patient self-awareness and emphasis on regular foot examinations during follow-up. Care of the diabetic foot should be multidisciplinary. Debridement, dressings and offloading are the pillars of local management. Simultaneous glycemic and infection control is also essential. Amputations are usually the treatment of last resort but occasionally can be considered early to allow for faster mobilization and rehabilitation. Causative factors like peripheral vasculopathy and neuropathy must also be appropriately treated.

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Pulse Oximetry as a Potential Screening Tool for Lower Extremity Arterial Disease in Asymptomatic Patients With Diabetes Mellitus

Cited by 6 publications

References 0 publications

Sensitivity and specificity of the ankle—brachial index to diagnose peripheral artery disease: a structured review

Sensitivity and specificity of the ankle—brachial index to diagnose peripheral artery disease: a structured review

Diabetic Foot Infections and the Role of Doppler USG in Prognosis

Diabetic Foot Ulcer – Diagnosis and Management

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