Azzopardi Yvonne Midolo, Gatt Alfred, Chockalingam Nachiappan, Formosa Cynthia
Faculty of Health Sciences, University of Malta, Malta.
Faculty of Health Sciences, University of Malta, Malta; School of Life Sciences and Education, Staffordshire University, United Kingdom.
Prim Care Diabetes. 2019 Feb;13(1):82-86. doi: 10.1016/j.pcd.2018.08.005. Epub 2018 Sep 7.
The aim of this study was to compare different screening modalities in the detection of PAD in a primary care setting.
Fifty participants living with Type 2 diabetes were recruited. Pulse palpation, waveform analysis, ankle brachial pressure index, absolute toe pressure, toe brachial pressure index and transcutaneous oxygen pressure were compared in the detection of peripheral arterial disease. One hundred limbs were included for analysis.
This study showed different results in peripheral arterial disease screening tests in the same group of participants. The highest percentage of participants who had PAD was for the Doppler Waveform (93.0%). This was followed by TBPI (72.0%), ABPI (57.0%), ATP (35.0%), TCPO (30.0%) and pulse palpation (23.0%). The difference between these percentages is significant (p<0.0005). The magnitude of the effect size is medium/moderate (Cramer's V=0.498).
This study demonstrates that inconsistencies exist between the agreement of the 6 different modalities used to detect PAD. These findings should create an awareness amongst clinicians when interpreting results of these tests. The authors advocate for urgent, more robust studies utilizing a gold standard modality for the diagnosis of PAD in order to provide evidence regarding which screening modalities would yield the most valid results.
本研究旨在比较在基层医疗环境中检测外周动脉疾病（PAD）的不同筛查方式。
招募了50名2型糖尿病患者。比较了脉搏触诊、波形分析、踝肱压力指数、绝对趾压、趾肱压力指数和经皮氧分压在检测外周动脉疾病中的效果。纳入100条肢体进行分析。
本研究在同一组参与者的外周动脉疾病筛查测试中显示出不同结果。患有外周动脉疾病的参与者中比例最高的是多普勒波形（93.0%）。其次是趾肱压力指数（72.0%）、踝肱压力指数（57.0%）、绝对趾压（35.0%）、经皮氧分压（30.0%）和脉搏触诊（23.0%）。这些百分比之间的差异具有显著性（p<0.0005）。效应大小的量级为中等（克莱默V系数=0.498）。
本研究表明，用于检测外周动脉疾病的6种不同方式之间的一致性存在差异。这些发现应使临床医生在解释这些测试结果时有所认识。作者主张开展紧急、更有力的研究，采用金标准方式诊断外周动脉疾病，以便提供关于哪种筛查方式能产生最有效结果的证据。
