Nurse-led rapid access vascular examination clinic triage reduces inappropriate referrals for peripheral arterial disease
Nurse-led rapid access vascular examination clinic triage reduces inappropriate referrals for peripheral arterial disease
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DOI：
10.1007/s11845-011-0679-3
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发表时间：
2011-03-01
影响因子：
2.1
通讯作者：
Harkin, D. W.
中科院分区：
文献类型：
--
作者：
Poots, J.;Kennedy, R.;Harkin, D. W.
外周动脉疾病引起间歇性跛行（IC），导致生活质量下降和严重的发病率。我们假设在护士引导的快速血管检查（RAVE）诊所对疑似IC的患者进行分诊，可以识别出需要血管手术评估的患者。对可疑IC的患者进行爱丁堡跛行问卷（ECQ）和动脉多普勒评估，结合节段波形分析和踝臂压力指数（ABPI）的计算。在451例连续患者中，平均年龄为65岁（范围30-89岁）。心血管风险因素包括：173/451（38%）当前吸烟者（162/451（36%）为既往吸烟者）;糖尿病，22%;高血压，46%;缺血性心脏病（心绞痛），29%;血脂异常，27%。治疗风险调整包括：抗血小板治疗，64.4%;降脂治疗，57.8%。264/451（59%）例患者的ABPI读数异常，209/451（46.3%）例患者的比值< 0.9，48/451（10.6%）例患者的比值> 1.3，7/451（1.5%）例患者的血管不可压缩。451例中187例（41%）ABPI正常（比值> 0.9和< 1.3，三相多普勒波形），这些患者被认为是不适当的转诊。对于ABPI异常（1.3）的PAD患者< 0.9 or >，多普勒波形分析比ECQ更敏感和特异，41%的病例仅根据临床病史诊断IC是不准确的，导致不适当的血管外科治疗。多普勒波形分析预测ABPI < 0.9具有良好的敏感性和特异性。在初级保健中进行ABPI测量可以更有效地利用临床资源。
Peripheral arterial disease causing intermittent claudication (IC) causes decreased quality of life and significant morbidity. We hypothesized that triage of patients referred with suspected IC at a nurse-led rapid access vascular examination (RAVE) clinic would identify those patients requiring vascular surgery assessment.A prospective cohort study was performed. Patients referred with suspected IC were assessed using the Edinburgh claudication questionnaire (ECQ) and arterial Doppler assessment with segmental waveform analysis and calculation of ankle brachial pressure index (ABPI). Data were collected regarding cardiovascular risk and its modification.Of 451 consecutive patients, mean age was 65 years (range 30-89). Cardiovascular risk factors included: 173/451 (38%) current smokers (162/451 (36%) were ex-smokers); diabetes, 22%; hypertension, 46%; ischaemic heart disease (angina), 29%; dyslipidaemia, 27%. Therapeutic risk modifications included: antiplatelet therapy, 64.4%; lipid-lowering therapy, 57.8%. abnormal ABPI readings were present in 264/451 (59%), with ratio < 0.9 in 209/451 (46.3%), > 1.3 in 48/451 (10.6%), and incompressible vessels 7/451 (1.5%). Normal ABPI (ratio > 0.9 and < 1.3, triphasic Doppler waveforms) were found in 187/451 (41%), these patient were considered inappropriate referrals. Considering those patient with PAD diagnosed on abnormal ABPI (< 0.9 or > 1.3), Doppler waveform analysis was more sensitive and specific than ECQ.Diagnosis of IC with clinical history alone is inaccurate in 41 percent of cases, leading to inappropriate referral to vascular surgery. Doppler waveform analysis had excellent sensitivity and specificity for prediction of ABPI < 0.9. ABPI measurement in primary care could result in a more efficient use of clinical resources.