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. 2017 Dec 19:10:58.
doi: 10.1186/s13047-017-0236-z. eCollection 2017.

Diagnostic accuracy of resting systolic toe pressure for diagnosis of peripheral arterial disease in people with and without diabetes: a cross-sectional retrospective case-control study

Peta Ellen Tehan  1   2 , Alex Louise Barwick  3 , Mathew Sebastian  4   5 , Vivienne Helaine Chuter  1
Affiliations

Diagnostic accuracy of resting systolic toe pressure for diagnosis of peripheral arterial disease in people with and without diabetes: a cross-sectional retrospective case-control study

Peta Ellen Tehan et al. J Foot Ankle Res. .

Abstract

Background: The resting systolic toe pressure (TP) is a measure of small arterial function in the periphery. TP is used in addition to the ankle-brachial index when screening for peripheral arterial disease (PAD) of the lower limb in those with diabetes, particularly in the presence of lower limb medial arterial calcification. It may be used as an adjunct assessment of lower limb vascular function and as a predictor of wound healing. The aim of this study was to determine the diagnostic accuracy of TP for detecting PAD in people with and without diabetes.

Methods: This was a retrospective case-control study. Two researchers extracted information from consecutive patient records, including TP measurements, colour Duplex ultrasound results, demographic information, and medical history. Measures of diagnostic accuracy were determined by receiver operating curve (ROC) analysis, and calculation of sensitivity, specificity, and positive and negative likelihood ratios.

Results: Three hundred and nintey-four participants with suspected PAD were included. In the diabetes group (n = 176), ROC analysis of TP for detecting PAD was 0.78 (95%CI: 0.69 to 0.84). In the control group (n = 218), the ROC of TP was 0.73 (95%CI: 0.70 to 0.80). TP had highest sensitivity when anatomical distribution of disease was both proximal and distal (diabetes group: 79.49%, the control group: 82.61%). TP yielded highest sensitivity in mild disease (50-75% stenosis) in diabetes group, (81.82%) and moderate disease (>75% stenosis) in control group (80.77%).

Conclusions: Our findings indicate that TPs are useful to assist in diagnosing PAD in clinical practice, however, results should be interpreted with caution due to the small probability of PAD being present with a negative test.

Keywords: Peripheral arterial disease; Sensitivity; Specificity; Toe pressure.

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Conflict of interest statement

This research was completed under the ethical approval of the University of Newcastle ethics committee approval number H2010–1230.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
ROC analysis of TP for detecting PAD in the whole population
Fig. 2
Fig. 2
ROC analysis of TP for detecting PAD in people with diabetes
Fig. 3
Fig. 3
ROC analysis of TP for detecting PAD in people without diabetes
See this image and copyright information in PMC

References

    1. Belch JF, Topol EJ, Agnelli G, et al. Critical issues in peripheral arterial disease detection and management: a call to action. Arch Intern Med. 2003;163(8):884–892. doi: 10.1001/archinte.163.8.884. - DOI - PubMed
    1. Aerden D, Massaad D, von Kemp K, van Tussenbroek F, Debing E, Keymeulen B, Van den Brande P. The ankle–brachial index and the diabetic foot: a troublesome marriage. Ann Vasc Surg. 2011;25(6):770–777. doi: 10.1016/j.avsg.2010.12.025. - DOI - PubMed
    1. Okamoto K, Oka M, Maesato K, Ikee R, Mano T, Moriya H, Ohtake T, Kobayashi S. Peripheral arterial occlusive disease is more prevalent in patients with Hemodialysis: comparison with the findings of multidetector-row computed tomography. Am J Kidney Dis. 2006;48(2):269–276. doi: 10.1053/j.ajkd.2006.04.075. - DOI - PubMed
    1. Tehan P, Bray A, Keech R, Rounsley R, Carruthers A, Chuter VH. Sensitivity and specificity of the toe-brachial index for detecting peripheral arterial disease. J Ultrasound Med. 2015;34(10):1737–1743. doi: 10.7863/ultra.15.14.09071. - DOI - PubMed
    1. Ibrahim A, Jude E, Langton K, Martinez-De JF, Harkless L, Gawish H, Huang Y, Labovitz J, Xu Z, Pendsey S, Liu F, Sadikot S, Cho N. IDF Clinical Practice recommendations on the diabetic foot. Belgium: International Diabetes Federation; 2017.

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