How reliable are our screening tools for peripheral arterial disease (PAD)? A recently published meta-analysis suggests that while our current diagnostic testing measures are promising, one should be wary of relying upon any one tool in isolation in patients with diabetes.
In their 2020 study in the Journal of Vascular Surgery, Normahani and coworkers reviewed and analyzed studies to evaluate the accuracy of bedside testing for PAD in patients with diabetes.1 In examining the diagnostic accuracy of the ankle-brachial pressure index (ABPI), the toe brachial pressure index (TBPI) and the tibial waveform assessment, these authors reviewed 11 studies (including a total of 1,543 limbs).
The ankle-brachial pressure index reportedly had a sensitivity of 63.5 percent and a specificity of 89.3 percent.1 The toe-brachial pressure index had a sensitivity of 83 percent but a specificity of 66.3 percent. According to the study authors, the tibial waveform assessment had a specificity of 86.8 percent and a sensitivity of 82.8 percent.
These findings emphasize using a range of tests as well as good quality common sense and clinical findings from the physical examination. There is no single test yet devised to fully rule in or rule out common sense diagnosis, and communication with our patients and other surgical/medical team members.
We need to keep doing our best to advance how we measure what we manage!
Dr. Armstrong is Professor of Surgery at the Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA).
Editor’s note: This blog originally appeared at: https://diabeticfootonline.com/2020/12/10/meta-analysis-of-the-diagnostic-accuracy-of-point-of-care-tests-for-peripheral-arterial-disease-in-people-with-diabetes/ . It is adapted with permission from the author.
1. Normahani P, Mustafa C, Shalhoub J, et al. A systematic review and meta-analysis of the diagnostic accuracy of point-of-care tests used to establish the presence of peripheral arterial disease in patients with diabetes. J Vasc Surg. 2020. doi: 10.1016/j.jvs.2020.11.030. Accessed January 12, 2021.