Bedside Toe Pressures Measurements in a Department of Vascular Surgery: A Study of Diagnostic Accuracy

Gine L. Glargaard; Christian Høyer; Annette Høgh

doi:10.1016/j.ejvs.2020.02.013

Bedside Toe Pressures Measurements in a Department of Vascular Surgery: A Study of Diagnostic Accuracy

Gine L. Glargaard^*, Christian Høyer, Annette Høgh

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

2 Citationer (Scopus)

Abstract

Objective: In patients with peripheral arterial disease (PAD), measurements of distal blood pressure form the basis of assessing the severity of the disease along with symptoms and objective findings. The reliability and accuracy of a fully automated bedside device (SysToe) vs. strain gauge plethysmography (SGP) in patients with low toe pressures in a bedside setting in an outpatient clinic of vascular surgery were investigated. Methods: This was a prospective, single blinded study carried out in compliance with the Standards of Reporting of Diagnostic Accuracy Studies. A total of 94 outpatients with symptomatic PAD in an outpatient vascular surgery clinic were included and had index measurements performed with the automated bedside device in a bedside setting by observers with no training in routine distal pressure measurements. SGP reference measurements were performed in a vascular laboratory. Results: There was agreement between modalities regarding the diagnostic classification of chronic limb threatening ischaemia (CLTI) in 79/94 (84%) patients. For detection of CLTI, Cohen's kappa was 0.57 with a sensitivity of 94%, specificity of 82%, positive predictive value (PPV) 52%, and negative predictive value (NPV) 98%. On average, the automated bedside device underestimated the pressures, compared with the SGP. The mean difference between SGP and SysToe was 9 ± 16 mmHg for right limbs and 10 ± 16 mmHg for left limbs (p < .001). Conclusion: The automated bedside device showed a high sensitivity and a high NPV for excluding CLTI. However, the low PPV may result in overdiagnosis. The automated bedside device may function as a screening tool identifying patients in need of further diagnostics with more accurate equipment, for example SGP.

Originalsprog	Engelsk
Tidsskrift	European Journal of Vascular and Endovascular Surgery
Vol/bind	59
Nummer	6
Sider (fra-til)	965-971
Antal sider	7
ISSN	1078-5884
DOI	https://doi.org/10.1016/j.ejvs.2020.02.013
Status	Udgivet - jun. 2020

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Citationsformater

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title = "Bedside Toe Pressures Measurements in a Department of Vascular Surgery: A Study of Diagnostic Accuracy",

abstract = "Objective: In patients with peripheral arterial disease (PAD), measurements of distal blood pressure form the basis of assessing the severity of the disease along with symptoms and objective findings. The reliability and accuracy of a fully automated bedside device (SysToe) vs. strain gauge plethysmography (SGP) in patients with low toe pressures in a bedside setting in an outpatient clinic of vascular surgery were investigated. Methods: This was a prospective, single blinded study carried out in compliance with the Standards of Reporting of Diagnostic Accuracy Studies. A total of 94 outpatients with symptomatic PAD in an outpatient vascular surgery clinic were included and had index measurements performed with the automated bedside device in a bedside setting by observers with no training in routine distal pressure measurements. SGP reference measurements were performed in a vascular laboratory. Results: There was agreement between modalities regarding the diagnostic classification of chronic limb threatening ischaemia (CLTI) in 79/94 (84%) patients. For detection of CLTI, Cohen's kappa was 0.57 with a sensitivity of 94%, specificity of 82%, positive predictive value (PPV) 52%, and negative predictive value (NPV) 98%. On average, the automated bedside device underestimated the pressures, compared with the SGP. The mean difference between SGP and SysToe was 9 ± 16 mmHg for right limbs and 10 ± 16 mmHg for left limbs (p < .001). Conclusion: The automated bedside device showed a high sensitivity and a high NPV for excluding CLTI. However, the low PPV may result in overdiagnosis. The automated bedside device may function as a screening tool identifying patients in need of further diagnostics with more accurate equipment, for example SGP.",

keywords = "Bedside testing, Diagnostic test, Peripheral arterial disease, Toe brachial index",

author = "Glargaard, {Gine L.} and Christian H{\o}yer and Annette H{\o}gh",

year = "2020",

month = jun,

doi = "10.1016/j.ejvs.2020.02.013",

language = "English",

volume = "59",

pages = "965--971",

journal = "European Journal of Vascular and Endovascular Surgery",

issn = "1078-5884",

publisher = "W.B. Saunders Ltd",

number = "6",

}

Bedside Toe Pressures Measurements in a Department of Vascular Surgery: A Study of Diagnostic Accuracy. / Glargaard, Gine L.; Høyer, Christian ; Høgh, Annette.
I: European Journal of Vascular and Endovascular Surgery, Bind 59, Nr. 6, 06.2020, s. 965-971.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Bedside Toe Pressures Measurements in a Department of Vascular Surgery

T2 - A Study of Diagnostic Accuracy

AU - Glargaard, Gine L.

AU - Høyer, Christian

AU - Høgh, Annette

PY - 2020/6

Y1 - 2020/6

N2 - Objective: In patients with peripheral arterial disease (PAD), measurements of distal blood pressure form the basis of assessing the severity of the disease along with symptoms and objective findings. The reliability and accuracy of a fully automated bedside device (SysToe) vs. strain gauge plethysmography (SGP) in patients with low toe pressures in a bedside setting in an outpatient clinic of vascular surgery were investigated. Methods: This was a prospective, single blinded study carried out in compliance with the Standards of Reporting of Diagnostic Accuracy Studies. A total of 94 outpatients with symptomatic PAD in an outpatient vascular surgery clinic were included and had index measurements performed with the automated bedside device in a bedside setting by observers with no training in routine distal pressure measurements. SGP reference measurements were performed in a vascular laboratory. Results: There was agreement between modalities regarding the diagnostic classification of chronic limb threatening ischaemia (CLTI) in 79/94 (84%) patients. For detection of CLTI, Cohen's kappa was 0.57 with a sensitivity of 94%, specificity of 82%, positive predictive value (PPV) 52%, and negative predictive value (NPV) 98%. On average, the automated bedside device underestimated the pressures, compared with the SGP. The mean difference between SGP and SysToe was 9 ± 16 mmHg for right limbs and 10 ± 16 mmHg for left limbs (p < .001). Conclusion: The automated bedside device showed a high sensitivity and a high NPV for excluding CLTI. However, the low PPV may result in overdiagnosis. The automated bedside device may function as a screening tool identifying patients in need of further diagnostics with more accurate equipment, for example SGP.

AB - Objective: In patients with peripheral arterial disease (PAD), measurements of distal blood pressure form the basis of assessing the severity of the disease along with symptoms and objective findings. The reliability and accuracy of a fully automated bedside device (SysToe) vs. strain gauge plethysmography (SGP) in patients with low toe pressures in a bedside setting in an outpatient clinic of vascular surgery were investigated. Methods: This was a prospective, single blinded study carried out in compliance with the Standards of Reporting of Diagnostic Accuracy Studies. A total of 94 outpatients with symptomatic PAD in an outpatient vascular surgery clinic were included and had index measurements performed with the automated bedside device in a bedside setting by observers with no training in routine distal pressure measurements. SGP reference measurements were performed in a vascular laboratory. Results: There was agreement between modalities regarding the diagnostic classification of chronic limb threatening ischaemia (CLTI) in 79/94 (84%) patients. For detection of CLTI, Cohen's kappa was 0.57 with a sensitivity of 94%, specificity of 82%, positive predictive value (PPV) 52%, and negative predictive value (NPV) 98%. On average, the automated bedside device underestimated the pressures, compared with the SGP. The mean difference between SGP and SysToe was 9 ± 16 mmHg for right limbs and 10 ± 16 mmHg for left limbs (p < .001). Conclusion: The automated bedside device showed a high sensitivity and a high NPV for excluding CLTI. However, the low PPV may result in overdiagnosis. The automated bedside device may function as a screening tool identifying patients in need of further diagnostics with more accurate equipment, for example SGP.

KW - Bedside testing

KW - Diagnostic test

KW - Peripheral arterial disease

KW - Toe brachial index

UR - http://www.scopus.com/inward/record.url?scp=85082117454&partnerID=8YFLogxK

U2 - 10.1016/j.ejvs.2020.02.013

DO - 10.1016/j.ejvs.2020.02.013

M3 - Journal article

C2 - 32217116

AN - SCOPUS:85082117454

SN - 1078-5884

VL - 59

SP - 965

EP - 971

JO - European Journal of Vascular and Endovascular Surgery

JF - European Journal of Vascular and Endovascular Surgery

IS - 6

ER -

Bedside Toe Pressures Measurements in a Department of Vascular Surgery: A Study of Diagnostic Accuracy

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