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A systematic review and meta-analysis of the diagnostic accuracy of point-of-care tests used to establish the presence of peripheral arterial disease in people with diabetes

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Title: A systematic review and meta-analysis of the diagnostic accuracy of point-of-care tests used to establish the presence of peripheral arterial disease in people with diabetes
Authors: Normahani, P
Mustafa, C
Shalhoub, J
Davies, A
Norrie, J
Sounderajah, V
Smith, S
Jaffer, U
Item Type: Journal Article
Abstract: Objective There is currently no agreement as to which bedside test is the most useful for the diagnosis of PAD in diabetes. The aim of this systematic review and meta-analysis was to evaluate the performance of bedside tests for the detection of PAD in individuals with diabetes. Research design and methods MEDLINE and EMBASE databases were systematically searched for studies providing data on diagnostic performance of bedside tests used for the detection of PAD in people with diabetes. A meta-analysis was performed to obtain pooled estimates of sensitivity and specificity for the diagnosis of PAD. Results A total of 18 studies, reporting on a total of 3016 limbs of diabetic patients, were included in our qualitative review. Of these, eleven studies (1543 limbs) were included in the meta-analysis of diagnostic accuracy: ankle-brachial pressure index (ABPI, 9 studies, 1368 limbs, sensitivity 63.5% [95% CI 51.7-73.9%], specificity 89.3% [95% CI 81.1-94.2%]); toe-brachial pressure index (TBPI, 3 studies, 221 limbs, sensitivity 83.0% [95% CI 59.1-94.3%], specificity 66.3% [95% CI 41.3-84.6%]); and tibial waveform assessment (4 studies, 397 limbs, sensitivity 82.8% [95% CI 73.3-89.4%], specificity 86.8% [95% CI 75.5-93.3%]). Overall, there was a high risk of bias across studies, most frequently relating to patient selection and lack of blinding. Conclusions TBPI, pulse oximetry and tibial arterial waveform assessment have demonstrated some promise, warranting further investigation. Key words Diabetesdiabetic footdiagnosisfoot ulcerperipheral arterial disease
Issue Date: 1-May-2021
Date of Acceptance: 11-Nov-2020
URI: http://hdl.handle.net/10044/1/84966
DOI: 10.1016/j.jvs.2020.11.030
ISSN: 0741-5214
Publisher: Elsevier
Start Page: 1811
End Page: 1820
Journal / Book Title: Journal of Vascular Surgery
Volume: 73
Issue: 5
Copyright Statement: © 2020 by the Society for Vascular Surgery. Published by Elsevier Inc. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor/Funder: National Institute of Health Research
Keywords: Diabetes
Diabetic foot
Diagnosis
Foot ulcer
Peripheral arterial disease
11 Medical and Health Sciences
Cardiovascular System & Hematology
Publication Status: Published
Online Publication Date: 2020-12-03
Appears in Collections:Department of Surgery and Cancer
Faculty of Medicine



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