Accuracy and reliability of ankle-brachial index measurement using an oscillometric device versus the Doppler method
DOI:
https://doi.org/10.47196/diab.v57i1.662Keywords:
doppler, ankle-brachial index, lower limb ischemiaAbstract
Introduction: the measurement of the ankle-brachial index (ABI) is a first-line test with high diagnostic accuracy for the detection of peripheral vascular disease. The Doppler method, considered the gold standard, requires the device and a trained operator, which limits its use in primary care. Alternatively, an oscillometric method using an automated blood pressure device is a simple and affordable test that could minimize observer bias and eliminate the need for special training.
Objectives: to validate the diagnostic capacity of an automated oscillometric device against the Doppler method for ABI measurement.
Material and methods: diabetes mellitus type 1 and 2 (DM1 and DM2) patients older than 50 years with 1 or more cardiovascular risk factors were included. After 5 minutes lying down, SBP was recorded with a Welch Allyn DS 45-11 sphygmomanometer and Contec Sonoline B 8 Mhz Vascular Doppler in both posterior tibial arteries and in the right brachial artery. Subsequently, the same recordings were made with an Automatic Blood Pressure Monitor Model OMROM HEM-7130. The ABI of each lower limb and the diagnostic capabilities (sensitivity -S-, specificity -E-, concordance by kappa coefficient, positive predictive value -PPV- and negative predictive value -NPV-) of the oscillometric method to detect a pathological ABI were calculated by Doppler (≤0.90).
Results: 66 patients were evaluated, 52 men and 14 women, 7 DM1 and 59 DM2, 69 years old (SD 9.8) with a history of diabetes of 18.05 years (SD 12.01). The prevalence of PVD detected by Doppler (ABI ≤0.90) was 16.7% (95% CI 9.9-23.4). The oscillometric method to detect an ABI ≤0.90 by Doppler showed an S of 72.7% (95% CI 51.8-93.6), an E of 96.3% (95% CI 92.4-100), a concordance of 92.4% (95% CI 87.5-97.3), a PPV of 80.0% (95% CI 59.9-100) and a NPV of 94.6% (95% CI 90 .0-99.3).
Conclusions: the high NPV found (essential condition for a screening method) means that if the oscillometric method gives an ABI >0.90, there is a 94.6% chance that the Doppler ABI is not ≤0.90. The PPV of 80% found means that if the oscillometric ABI is ≤0.90, there is an 80% chance that the Doppler ABI is truly ≤0.90. Therefore, we consider that the simple measurement of ABI with the oscillometric method could be recommended in primary care, where fast, easy and reliable methods are adequate.
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