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Ankle-brachial index determination and peripheral arterial disease diagnosis by an oscillometric blood pressure device in primary care: validation and diagnostic accuracy study

Citation

Nelson, MR and Quinn, S and Winzenberg, TM and Howes, F and Shiel, L and Reid, CM, Ankle-brachial index determination and peripheral arterial disease diagnosis by an oscillometric blood pressure device in primary care: validation and diagnostic accuracy study, BMJ Open, 2, (5) Article e001689. ISSN 2044-6055 (2012) [Refereed Article]


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Copyright Statement

Copyright 2012 by the BMJ Publishing Group Ltd.

Official URL: http://bmjopen.bmj.com

DOI: doi:10.1136/bmjopen-2012-001689

Abstract

OBJECTIVES: To determine the level of agreement between a 'conventional' Ankle-Brachial Index (ABI) measurement (using Doppler and mercury sphygmomanometer taken by a research nurse) and a 'pragmatic' ABI measure (using an oscillometric device taken by a practice nurse) in primary care. To ascertain the utility of a pragmatic ABI measure for the diagnosis of peripheral arterial disease (PAD) in primary care. DESIGN: Cross-sectional validation and diagnostic accuracy study. Descriptive analyses were used to investigate the agreement between the two procedures using the Bland and Altman method to determine whether the correlation between ABI readings varied systematically. Diagnostic accuracy was assessed via sensitivity, specificity, accuracy, likelihood ratios, positive and negative predictive values, with ABI readings dichotomised and Receiver Operating Curve analysis using both univariable and multivariable logistic regression. SETTING: Primary care in metropolitan and rural Victoria, Australia between October 2009 and November 2010. PARTICIPANTS: 250 persons with cardiovascular disease (CVD) or at high risk (three or more risk factors) of CVD. RESULTS: Despite a strong association between the two method's measurements of ABI there was poor agreement with 95% of readings within 0.4 of the 0.9 ABI cut point. The multivariable C statistic of diagnosis of PAD was 0.89. Other diagnostic measures were sensitivity 62%, specificity 92%, positive predictive value 67%, negative predictive value 90%, accuracy 85%, positive likelihood ratio 7.3 and the negative likelihood ratio 0.42. CONCLUSIONS: Oscillometric ABI measures by primary care nurses on a population with a 22% prevalence of PAD lacked sufficient agreement with conventional measures to be recommended for routine diagnosis of PAD. This pragmatic method may however be used as a screening tool high-risk and overt CVD patients in primary care as it can reliably exclude the condition.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Nelson, MR (Professor Mark Nelson)
Author:Winzenberg, TM (Professor Tania Winzenberg)
Author:Howes, F (Dr Faline Howes)
ID Code:81274
Year Published:2012
Funding Support:National Health and Medical Research Council (544935)
Web of Science® Times Cited:9
Deposited By:Medicine (Discipline)
Deposited On:2012-11-28
Last Modified:2013-11-01
Downloads:300 View Download Statistics

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