Diagnostic value of signs and symptoms associated with peripheral arterial occlusive disease seen in general practice:a multivariable approach
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| Title: | Diagnostic value of signs and symptoms associated with peripheral arterial occlusive disease seen in general practice:a multivariable approach |
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| Authors: | Stoffers, H E, Kester, A D, Kaiser, V, Rinkens, P E, Knottnerus, J A |
| Source: | Stoffers, H E, Kester, A D, Kaiser, V, Rinkens, P E & Knottnerus, J A 1997, 'Diagnostic value of signs and symptoms associated with peripheral arterial occlusive disease seen in general practice : a multivariable approach', Medical Decision Making, vol. 17, no. 1, pp. 61-70. https://doi.org/10.1177/0272989X9701700107 |
| Publication Year: | 1997 |
| Collection: | Maastricht University Research Publications |
| Subject Terms: | Adult, Aged, Arterial Occlusive Diseases/diagnosis, Cross-Sectional Studies, Female, Humans, Male, Medical History Taking/statistics & numerical data, Middle Aged, Multivariate Analysis, Netherlands/epidemiology, Odds Ratio, Physical Examination/statistics & numerical data, Predictive Value of Tests, Primary Health Care, Regression Analysis |
| Description: | OBJECTIVES: To assess the diagnostic values of single and combined data from the history, physical examination, and medical record with regard to peripheral arterial occlusive disease (PAOD) in patients with leg complaints; to construct a multivariable model for the clinical diagnosis of PAOD by primary care physicians. SETTING: 18 general practice centers in The Netherlands. DESIGN: Cross-sectional comparison of signs, symptoms, and data from the medical record with the independently assessed ankle-brachial systolic pressure index (ABPI; cutoff point < 0.90); analysis: bivariate, multiple logistic regression (MLR). POPULATION: 2,455 individuals with leg complaints, aged 40.7-78.4 years; ABPI < 0.90 present in 9.2% of legs (11.7% of individuals). OUTCOME MEASURES: Clinical variables: sensitivity, specificity, positive and negative predictive values (PV+, PV-), diagnostic odds ratio (OR); models: likelihood ratio test, area under the receiver operating characteristic curve (AUC). RESULTS: Bivariate analysis: highest sensitivity: age more than 60 years (77.3%); highest specificity: wounds or sores on toes and foot (99.7%); highest PV+: typical intermittent claudication (IC) (45.0%) (abnormal foot pulses 41.3%); highest PV-: strong pulses of both foot arteries (97.7%). MRL: the best-performing model (AUC 0.89) consisted of ten clinical variables: gender (OR 1.5), age more than 60 (OR 2.2); IC (OR 3.5); palpation of the skin temperature of the feet (OR 2.5), palpation of both foot pulses [OR 16.4 (abnormal) and 7.0 (doubtful)], auscultation of the femoral artery (OR 3.5); previous diagnosis of IHD (OR 1.7) or diabetes (OR 1.6), history of smoking (OR 2.1), and elevated blood pressure (OR 1.5). The range of predicted probabilities was 0.4-98%. The Hosmer-Lemeshow goodness-of-fit test indicated good overall fit (p = 52). CONCLUSIONS: Palpation of both foot pulses is the key procedure for the clinical diagnosis of PAOD. Traditional clinical evaluation enables the general practitioner to exclude the diagnosis of ... |
| Document Type: | article in journal/newspaper |
| Language: | English |
| Relation: | info:eu-repo/semantics/altIdentifier/pmid/8994152; info:eu-repo/semantics/altIdentifier/wos/A1997WA74900007; info:eu-repo/semantics/altIdentifier/pissn/0272-989X; info:eu-repo/semantics/altIdentifier/eissn/1552-681X |
| DOI: | 10.1177/0272989X9701700107 |
| Availability: | https://cris.maastrichtuniversity.nl/en/publications/60b7ed23-3e63-4f61-84ad-2191aa1d3cb3 https://doi.org/10.1177/0272989X9701700107 |
| Rights: | info:eu-repo/semantics/closedAccess |
| Accession Number: | edsbas.106E8C96 |
| Database: | BASE |
Nájsť tento článok vo Web of Science | Abstract: | OBJECTIVES: To assess the diagnostic values of single and combined data from the history, physical examination, and medical record with regard to peripheral arterial occlusive disease (PAOD) in patients with leg complaints; to construct a multivariable model for the clinical diagnosis of PAOD by primary care physicians. SETTING: 18 general practice centers in The Netherlands. DESIGN: Cross-sectional comparison of signs, symptoms, and data from the medical record with the independently assessed ankle-brachial systolic pressure index (ABPI; cutoff point < 0.90); analysis: bivariate, multiple logistic regression (MLR). POPULATION: 2,455 individuals with leg complaints, aged 40.7-78.4 years; ABPI < 0.90 present in 9.2% of legs (11.7% of individuals). OUTCOME MEASURES: Clinical variables: sensitivity, specificity, positive and negative predictive values (PV+, PV-), diagnostic odds ratio (OR); models: likelihood ratio test, area under the receiver operating characteristic curve (AUC). RESULTS: Bivariate analysis: highest sensitivity: age more than 60 years (77.3%); highest specificity: wounds or sores on toes and foot (99.7%); highest PV+: typical intermittent claudication (IC) (45.0%) (abnormal foot pulses 41.3%); highest PV-: strong pulses of both foot arteries (97.7%). MRL: the best-performing model (AUC 0.89) consisted of ten clinical variables: gender (OR 1.5), age more than 60 (OR 2.2); IC (OR 3.5); palpation of the skin temperature of the feet (OR 2.5), palpation of both foot pulses [OR 16.4 (abnormal) and 7.0 (doubtful)], auscultation of the femoral artery (OR 3.5); previous diagnosis of IHD (OR 1.7) or diabetes (OR 1.6), history of smoking (OR 2.1), and elevated blood pressure (OR 1.5). The range of predicted probabilities was 0.4-98%. The Hosmer-Lemeshow goodness-of-fit test indicated good overall fit (p = 52). CONCLUSIONS: Palpation of both foot pulses is the key procedure for the clinical diagnosis of PAOD. Traditional clinical evaluation enables the general practitioner to exclude the diagnosis of ... |
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| DOI: | 10.1177/0272989X9701700107 |