Background We assessed the value of the medical history and physical examination in the diagnosis of peripheral vascular disease in diabetic subjects.
We performed a cross-sectional study in 631 diabetic veteran enrolleess of a general internal medicine clinic that compared data obtained from a history and clinical evaluations with the presence of severe peripheral vascular disease defined as an ankle-arm index (AAI) ¾ 0.5 derived from Doppler blood pressure measurement.
We identified 90 limbs with an AAI ¾ 0.05.
Results presented below apply to the right leg, but do not differ from the left.
Diminished or absent foot peripheral pulses (sensitivity 65%, specificity 78%), venous filling time>20 sec (sensitivity 22%, specificity 93,9%), age>65 years (sensitivity 83%, specificity 54%), claudication symptoms in<1 bloc (sensitivity 50%, specificity 87%), and patient reported history of physician diagnosed peripheral vascular disease (PVD) (sensitivity 80%, specificity 70%) had the largest positive (or smallest negative) likelihood ratios.
Capillary refill time>5 sec or foot characteristics (absent hair, blue/purple color, skin coolness, or atrophy) conveyed little diagnostic information.
Individual factors did not change disease probability to a clinically important degree.
A stepwise logistic regression model identified four factors significantly (p<0. (...)
Mots-clés Pascal : Vaisseau sanguin pathologie, Membre inférieur, Complication, Diabète, Epidémiologie, Diagnostic, Exploration clinique, Antécédent, Homme, Appareil circulatoire pathologie, Endocrinopathie
Mots-clés Pascal anglais : Vascular disease, Lower limb, Complication, Diabetes mellitus, Epidemiology, Diagnosis, Clinical investigation, Antecedent, Human, Cardiovascular disease, Endocrinopathy
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Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0423018
Code Inist : 002B21E01B. Création : 19/12/1997.