Normahani Pasha, Poushpas Sepideh, Alaa Mays, Bravis Vassiliki, Sounderajah Viknesh, Aslam Mohammed, Jaffer Usman
Imperial Vascular Unit, Imperial College NHS Healthcare Trust, London, United Kingdom.
Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
Ann Surg. 2022 Nov 1;276(5):e605-e612. doi: 10.1097/SLA.0000000000004545. Epub 2020 Dec 29.
We compared the diagnostic performance of a novel point-of-care duplex ultrasound test (podiatry ankle duplex scan; PAD-scan) against commonly used bedside tests for the detection of PAD in diabetes.
PAD is a major risk factor for diabetic foot ulceration and amputation. Its diagnosis is fundamental though challenging. Although a variety of bedside tests are available, there is no agreement as to which is the most useful. PAD-scan may be advantageous over current tests as it allows for vessel visualization and more accurate arterial waveform assessment. However, its accuracy has not been previously evaluated.
From March to October 2019, we recruited 305 patients from 2 diabetic foot clinics. The diagnostic performance of ankle-brachial pressure index, toe-brachial pressure index, transcutaneous pressure of oxygen, pulse palpation, and ankle waveform assessment using PAD-scan and Doppler devices (audible and visual waveform assessment) were assessed. The reference test was a full lower limb duplex ultrasound.
Based on the reference test, 202 (66.2%) patients had evidence of PAD. PAD-scan had a significantly higher sensitivity [95%, confidence interval (CI) 90%-97%) as compared to all other tests. Particularly low sensitivities were seen with pulse palpation (43%, CI 36%-50%) and transcutaneous pressure of oxygen (31%, CI 24%-38%). PAD-scan had a lower specificity (77%, CI 67%-84%) compared to toe-brachial pressure index (86%, CI 78%-93%; P < 0.001), but not statistically different when compared to all other tests.
PAD-scan has superior diagnostic utility and is a valid first line investigation.
我们比较了一种新型即时护理双功能超声检查（足病科踝关节双功能扫描；PAD扫描）与常用的床边检查在糖尿病患者中检测外周动脉疾病（PAD）的诊断性能。
PAD是糖尿病足溃疡和截肢的主要危险因素。其诊断至关重要但具有挑战性。尽管有多种床边检查方法，但对于哪种最有用尚无共识。PAD扫描可能比目前的检查更具优势，因为它可以实现血管可视化并进行更准确的动脉波形评估。然而，其准确性此前尚未得到评估。
2019年3月至10月，我们从2个糖尿病足诊所招募了305名患者。评估了踝肱压力指数、趾肱压力指数、经皮氧分压、脉搏触诊以及使用PAD扫描和多普勒设备进行的踝关节波形评估（听觉和视觉波形评估）的诊断性能。参考检查为全下肢双功能超声。
基于参考检查，202例（66.2%）患者有PAD证据。与所有其他检查相比，PAD扫描的灵敏度显著更高[95%，置信区间（CI）90%-97%]。脉搏触诊（43%，CI 36%-50%）和经皮氧分压（31%，CI 24%-38%）的灵敏度特别低。与趾肱压力指数（86%，CI 78%-93%；P<0.001）相比，PAD扫描的特异性较低（77%，CI 67%-84%），但与所有其他检查相比无统计学差异。
PAD扫描具有卓越的诊断效用，是一种有效的一线检查方法。
