Performance of physical examination versus ultrasonography to detect stenosis in haemodialysis arteriovenous fistula

Abstract

Purpose: The overall purpose of this study is to compare the accuracy of physical examination (PE) versus ultrasonography (US) in people with arteriovenous fistula (AVF).

Methods: This is a cross-sectional study with a total of 99 patients attended by the vascular radiology unit for AVF evaluation during January - March 2015. PE and ultrasonography were blinded performed by different radiologists. For complete and individual signs of PE, sensitivity, specificity, predictive positive (PPV) and negative (PNV) value, likelihood ratios (LR) and Cohen's κ value were measured.

Results: According to ultrasonography, the presence of stenosis was identified in 57 (58%) patients, and 61 (62%) by PE. The accuracy of PE for the diagnosis of AVF was sensitivity 82%, specificity 67%, PPV 77%, NPV 74%, LR 2.74 and 0.26. There was a moderate agreement beyond chance between PE and ultrasonography (κ = 0.5).

Conclusions: PE has shown a moderate accuracy to detect stenosis. With non-ultrasonography availability Haemodialysis Units can get benefit to optimize VA survival and professionals should improve its basic skills.