Smieja M, Hunt D L, Edelman D, Etchells E, Cornuz J, Simel D L
Department of Medicine, McMaster University Medical Centre, Hamilton Health Sciences Corporation, Ont., Canada.
J Gen Intern Med. 1999 Jul;14(7):418-24. doi: 10.1046/j.1525-1497.1999.05208.x.
We compared the reproducibility and accuracy of conventional clinical examination of the diabetic foot to monofilament examination. We also sought to simplify the monofilament examination by reducing it to fewer touch points.
In a cross-sectional study at 10 centers in the United States, Canada, and Switzerland, general internists and residents performed a structured history and physical examination for neuropathy on the feet of diabetic patients. Independent examination by two observers included monofilament sensation, pinprick, vibration, position sense, and ankle reflexes.
A total of 304 patients were examined by at least one practitioner, and 200 received duplicate examinations. Monofilament examination and ankle reflexes had the best reproducibility, with moderate agreement (kappa = 0.59); pinprick, position, and vibration sense had fair agreement (kappa = 0.28-0.36). No component of the history or physical examination, singly or in aggregate, was both sensitive and specific for identifying a patient with an abnormal monofilament examination. A simplified monofilament examination using only 4 sites per foot (total 8 sites) detected 90% of patients with an abnormal 16-site monofilament evaluation.
Conventional clinical examination had low reproducibility and correlated poorly with monofilament examination for the identification of the at-risk patient. The Semmes-Weinstein monofilament examination, a reproducible, valid, and generalizable test of foot sensation, is recommended as the screening procedure of choice for examining diabetic feet.
我们比较了糖尿病足常规临床检查与单丝检查的可重复性和准确性。我们还试图通过减少接触点数量来简化单丝检查。
在美国、加拿大和瑞士的10个中心进行的一项横断面研究中，普通内科医生和住院医师对糖尿病患者的足部进行了结构化病史和神经病变体格检查。由两名观察者进行的独立检查包括单丝感觉、针刺觉、振动觉、位置觉和踝反射。
至少一名医生对304例患者进行了检查，其中200例接受了重复检查。单丝检查和踝反射的可重复性最佳，一致性中等（kappa = 0.59）；针刺觉、位置觉和振动觉的一致性一般（kappa = 0.28 - 0.36）。病史或体格检查的任何单项或综合组成部分，对于识别单丝检查异常的患者，既不敏感也不特异。一种简化的单丝检查，每只脚仅使用4个部位（共8个部位），检测出了90%在16部位单丝评估中异常的患者。
常规临床检查的可重复性较低，在识别高危患者方面与单丝检查的相关性较差。Semmes-Weinstein单丝检查是一种可重复、有效且可推广的足部感觉测试，推荐作为检查糖尿病足的首选筛查方法。
