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. 2023 Feb;31(1):115-121.
doi: 10.1177/17085381211059665. Epub 2022 Feb 10.

The Edinburgh Claudication Questionnaire has poor diagnostic accuracy in people with intermittent claudication

Saïd Ibeggazene  1   2 , Andrew Stirrup  1 , Sean Pymer  1 , Joanne Palmer  1 , Paris L Cai  1 , George E Smith  1 , Ian C Chetter  1
Affiliations

The Edinburgh Claudication Questionnaire has poor diagnostic accuracy in people with intermittent claudication

Saïd Ibeggazene et al. Vascular. 2023 Feb.

Abstract

Background: The screening and diagnosis of intermittent claudication is a challenging process and often relies on the expertise of specialist vascular clinicians. We sought to investigate the diagnostic performance of the Edinburgh Claudication Questionnaire (ECQ) as a screening tool for referrals of suspected intermittent claudication from primary to secondary care.

Method: Prospectively, 100 referrals from primary care with a stated diagnosis or query regarding intermittent claudication were recruited. All participants who completed the ECQ, underwent an anklebrachial pressure index (ABPI) assessment and treadmill exercise testing. Outcomes of the ECQ were compared to clinical diagnoses of intermittent claudication.

Results: The ECQ had a sensitivity of 46.8% (95% CI: 27-65%), specificity of 63.2% (95% CI: 43-82%) and accuracy of 53.0% (95% CI: 43-63%). The diagnostic performance was not changed by combining the ECQ with a positive ABPI or post-exercise ABPI outcome for PAD.

Conclusion: The ECQ had a poor diagnostic performance in this cohort. Considering the results found here and in other recent studies, the utility of the ECQ as a screening tool and epidemiological survey tool must be questioned. Novel, low-resource diagnostic tools are needed in this population.

Keywords: Intermittent claudication; diagnosis; peripheral artery disease.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Diagnostic performance of the Edinburgh Claudication Questionnaire for detecting intermittent claudication.
Figure 2.
Figure 2.
Receiver operating characteristic curves are presented for detecting intermittent claudication for the Edinburgh Claudication Questionnaire (ECQ), ankle-brachial pressure index (ABPI), ECQ and ABPI combined, post-exercise ABPI, and the ECQ when only questions 3 and 5 were considered. The area under the curve for each was as follows: ECQ, 0.55 (95% CI [0.43–0.67]); resting ABPI, 0.59 (95% CI [0.47–0.70]); post-exercise ABPI was 0.58 (95% CI [0.46–0.69]); combined ECQ and resting ABPI, 0.56 (95% CI [0.44–0.67]); and the ECQ when only questions 3 and 5 were considered, 0.77 (95% CI [0.69–0.87]).
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