Reliability of the Edinburgh Claudication Questionnaire for Identifying Symptomatic PAD in General Practice

Abstract

The Edinburgh Claudication Questionnaire (ECQ) was developed to help identify peripheral arterial disease (PAD) in the general population but has not been validated against diagnostic arterial imaging methods such as Duplex Vascular Ultrasound Scanning (DUS). In the present study, we assessed the accuracy of the ECQ for diagnosis using DUS. As part of a National Institute of Health Research funded project looking at novel diagnostic methods, 250 patients were studied from 15 general practices across North East England from May 2015 and November 2016. Practices identified those with a PAD diagnosis from their registers as well as age- and sex-matched controls. All the ECQs were recorded by a vascular specialist nurse. Duplex vascular ultrasound scanning was used as a reference standard for the diagnosis of occlusive PAD. The ECQ had a sensitivity of 52.5% (95% CI: 42.3%-62.5%), specificity of 87.1% (95% CI: 80.6%-92.0%), positive likelihood ratio of 4.06 (95% CI: 2.57-6.42), and negative likelihood ratio of 0.55 (95% CI: 0.44-0.68) compared with reference standard DUS. The ECQ has relatively poor overall diagnostic test accuracy in isolation. It may be helpful in ruling out PAD or as a supplementary test to improve diagnosis of symptomatic disease in General Practice.

The Edinburgh Claudication Questionnaire has poor diagnostic accuracy in people with intermittent claudication

“…In this study, the ECQ was good at ruling out PAD (specificity: 87%) but not detecting it (sensitivity: 48%). Two other UK studies have found similar performance for detecting PAD in individuals with leg pain using the ECQ, with Boylan et al 26 finding a sensitivity of 53% and a specificity of 87% and Poots et al 27 finding a sensitivity of 57% and specificity of 82%. Criqui et al 14 found worse results using the Rose Claudication Questionnaire with a sensitivity of 9.2% and specificity of 99% for detecting large-vessel PAD.…”

Prospective Assessment of the Diagnostic Accuracy of Multi-site Photoplethysmography Pulse Measurements for Diagnosis of Peripheral Artery Disease in Primary Care

“…11 This study compares the diagnostic performance of MPPG and ABPI with DUS and measures the concordance of MPPG and ABPI. Diagnostic performances of ECQ 24 and GP PAD registers 25 for the same participants compared with DUS have already been reported.…”

“…Diagnostic accuracy for peripheral arterial disease (PAD) of primary care PAD registers,25 ECQ,24 anklebrachial pressure index (ABPI) and multi-site photoplethysmography (MPPG) vs duplex ultrasound reference test. n: number of pairwise comparisons with conclusive index test and reference test; LR+:…”

One-year follow-up of patients screened for lower extremity arterial disease

“…At the follow-up examination, patients were first asked to fill in the Edinburgh claudication questionnaire (ECQ) again, which is a validated and frequently used tool for LEAD and IC screening [22]. By doing so, we examined changes in the symptoms of patients with clear signs of LEAD and those without them.…”

“…Guidelines could be particularly important in establishing the diagnosis, however according to a recent study there are several discrepancies between the different guidelines, especially concerning the diagnosis and treatment of asymptomatic patients [20]. There is a limited adherence concerning the risks and complications of LEAD, which further worsens the chance of early detection [12,17,[21][22][23][24][25].…”