Physical examination to screen for peripheral artery disease in a defined Primary Care population: A diagnostic accuracy study
Physical examination to screen for peripheral artery disease in a defined Primary Care population: A diagnostic accuracy study
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DOI：
10.1111/ijcp.13253
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发表时间：
2018-11-01
影响因子：
2.6
通讯作者：
Notario-Pacheco, Blanca
中科院分区：
文献类型：
--
作者：
Herraiz-Adillo, Angel;Pinar-Serrano, Olga;Notario-Pacheco, Blanca
背景：外周动脉疾病（PAD）是一种未被诊断的流行性疾病，意味着高心血管风险。专业人员通常依赖于体格检查来筛查PAD.Objective：评估体格检查在农村初级保健人群中筛查PAD的诊断准确性，并评估护士-医生在踏板脉搏触诊中的一致性水平。两名经验丰富的专业人员进行的诊断准确性研究（医生-护士）前瞻性地进行了足部脉搏触诊（分级为缺失、减少、正常或边界）、股骨杂音听诊和小腿围在158名连续受试者中，将多普勒ABI（参考试验，阳性截止值：0.9 >= ABI >= 1.4）与指数试验进行比较。入选标准：有糖尿病、血脂异常、高血压、吸烟史或年龄≥ 65岁。结果：315条患肢中，38条患肢（12.1%）有PAD。足背（DP）和胫后（PT）脉搏消失分别有37条（11.7%）和67条（21.3%）。关于护士评价，如果DP或PT缺失，则设置阳性检测（更灵敏的临界值），灵敏度= 86.8（95% CI：74.8-98.9），特异性=82.7（95% CI：78.0-87.3），似然比+ = 5.01（95% CI：3.77-6.67），似然比-= 0.16（95% CI：0.07-0.36），诊断比值比（dOR）=31.5（95% CI：11.7-84.8）。年龄、糖尿病和钙化（ABI >= 1.4）影响足部触诊的假阴性率。医师-护士加权Kappa系数=0.649（95%CI：0.599-0.699）。股动脉杂音听诊的dOR=3.8（95% CI：1.1-13.1），小腿围
Introduction: Peripheral arterial disease (PAD) is an underdiagnosed prevalent disease which implies high cardiovascular risk. Professionals usually depend on physical examination to screen for PAD.Objective: To assess the diagnostic accuracy of physical examination to screen for PAD in a rural Primary Care population and to evaluate the nurse-physician level of agreement in pedal pulse palpation.Methods: Diagnostic accuracy study in which two experienced professionals (physician-nurse) prospectively performed pedal pulse palpation (grading as absent, reduced, normal, or bounding), femoral bruit auscultation and calf circumference (index tests) comparing with Doppler ABI (reference test, positive cut-off: 0.9 >= ABI >= 1.4) in 158 consecutive subjects. Inclusion criteria: presence of diabetes, dyslipidaemia, hypertension, smoking habit (current or former), or age >= 65.Results: Of 315 legs included, PAD was confirmed in 38 (12.1%) legs. Absent dorsalis pedis (DP) and posterior tibial (PT) pulses were found in 37 (11.7%) and 67 (21.3%) legs, respectively. Regarding nurse evaluation, when a positive test was set if DP or PT were absent (more sensitive cut-off), sensitivity was = 86.8 (95% CI: 74.8-98.9), specificity=82.7 (95% CI: 78.0-87.3), likelihood ratio+ = 5.01 (95% CI: 3.77-6.67), likelihood ratio-= 0.16 (95% CI: 0.07-0.36), and diagnostic odds ratio (dOR)=31.5 (95% CI: 11.7-84.8). Age, diabetes, and calcification (ABI >= 1.4) influenced the rate of a false negative finding in pedal palpation. Physician-nurse weighted kappa coefficient was=0.649 (95% CI: 0.599-0.699). The presence of a femoral bruit auscultation had a dOR=3.8 (95% CI: 1.1-13.1), and a calf circumference