Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review

Rachael O. Forsythe*, Jan Apelqvist, Edward J. Boyko, Robert Fitridge, Joon Pio Hong, Konstantinos Katsanos, Joseph L. Mills, Sigrid Nikol, Jim Reekers, Maarit Venermo, R. Eugene Zierler, Nicolaas C. Schaper, Robert J. Hinchliffe

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

The accurate identification of peripheral artery disease (PAD) in patients with diabetes and foot ulceration is important, in order to inform timely management and to plan intervention including revascularisation. A variety of non-invasive tests are available to diagnose PAD at the bedside, but there is no consensus as to the most useful test, or the accuracy of these bedside investigations when compared to reference imaging tests such as magnetic resonance angiography, computed tomography angiography, digital subtraction angiography or colour duplex ultrasound. Members of the International Working Group of the Diabetic Foot updated our previous systematic review, to include all eligible studies published between 1980 and 2018. Some 15380 titles were screened, resulting in 15 eligible studies (comprising 1563 patients, of which >80% in each study had diabetes) that evaluated an index bedside test for PAD against a reference imaging test. The primary endpoints were positive likelihood ratio (PLR) and negative likelihood ratio (NLR). We found that the most commonly evaluated test parameter was ankle brachial index (ABI) 0.75 makes the diagnosis of PAD less likely (NLR 0.14-0.24), whereas pulse oximetry may be used to suggest the presence of PAD (if toe saturation

Original languageEnglish
Article numbere3277
Pages (from-to)1-17
Number of pages17
JournalDiabetes-metabolism Research and Reviews
Volume36
Issue number1
DOIs
Publication statusPublished - 16 Mar 2020

Keywords

  • ACCURACY
  • CRITICAL LIMB ISCHEMIA
  • FOOT ULCER
  • HEALTH
  • INDEX
  • PRESSURE
  • PREVALENCE
  • RISK-FACTORS
  • TOOL
  • VASCULAR-DISEASE
  • amputation
  • diabetes
  • diabetic foot
  • diagnosis
  • foot ulcer
  • peripheral artery disease
  • PREDICTION
  • FOOT ULCERS

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