Back to Search
Start Over
Physical examination to screen for peripheral artery disease in a defined Primary Care population: A diagnostic accuracy study
- Source :
- International Journal of Clinical Practice. 72:e13253
- Publication Year :
- 2018
- Publisher :
- Hindawi Limited, 2018.
-
Abstract
- 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
- Subjects :
- Male
medicine.medical_specialty
Population
Physical examination
030204 cardiovascular system & hematology
Sensitivity and Specificity
Asymptomatic
Palpation
Peripheral Arterial Disease
03 medical and health sciences
0302 clinical medicine
Diabetes mellitus
Internal medicine
medicine
Humans
030212 general & internal medicine
education
False Negative Reactions
Physical Examination
Aged
Aged, 80 and over
Observer Variation
Leg
education.field_of_study
Primary Health Care
medicine.diagnostic_test
business.industry
General Medicine
Auscultation
Middle Aged
medicine.disease
body regions
Cardiology
Diagnostic odds ratio
Female
medicine.symptom
business
Subjects
Details
- ISSN :
- 13685031
- Volume :
- 72
- Database :
- OpenAIRE
- Journal :
- International Journal of Clinical Practice
- Accession number :
- edsair.doi.dedup.....930ff2e1b05d884396ebced03a4d356f