| Titre : | Diagnostic utility of the history and physical examination for peripheral vascular disease among patients with diabetes mellitus. (1997) |
| Auteurs : | E.J. BOYKO ; J.H. AHRONI ; D. DAVIGNON ; R.L. PRIGEON ; D.G. Smith ; V. STENSEL ; Department of Medicine. University of Washington. Seattle Washington. USA ; Medical Service. Veterans Affairs Puget Sound Health Care System. Seattle Washington. USA |
| Type de document : | Article |
| Dans : | Journal of clinical epidemiology (vol. 50, n° 6, 1997) |
| Pagination : | 659-668 |
| Langues: | Anglais |
| Mots-clés : | Vaisseau sanguin [pathologie] ; Membre inférieur ; Complication ; Diabète ; Epidémiologie ; Diagnostic ; Examen clinique ; Antécédent médical ; Homme ; Appareil circulatoire [pathologie] ; Glande endocrine [pathologie] |
| Résumé : | [BDSP. Notice produite par INIST VR0x0UNs. Diffusion soumise à autorisation]. Background We assessed the value of the medical history and physical examination in the diagnosis of peripheral vascular disease in diabetic subjects. Methods : 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) 0.5 derived from Doppler blood pressure measurement. Results : We identified 90 limbs with an AAI 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. (...) |
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