Evaluating the prognostic performance of bedside tests used for peripheral arterial disease diagnosis in the prediction of diabetic foot ulcer healing
Introduction Diabetic foot ulceration (DFU) is a common and challenging complication of diabetes. Risk stratification can guide further management. We aim to evaluate the prognostic performance of bedside tests used for peripheral arterial disease (PAD) diagnosis to predict DFU healing.Research desi...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-04-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/11/2/e003110.full |
| _version_ | 1797770897970429952 |
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| author | Pasha Normahani Usman Jaffer Alun H Davies Viknesh Sounderajah Hussein Elghazaly Theodore Howard Sharan Sanjay Omer G Mohamed Zaheer Mehar |
| author_facet | Pasha Normahani Usman Jaffer Alun H Davies Viknesh Sounderajah Hussein Elghazaly Theodore Howard Sharan Sanjay Omer G Mohamed Zaheer Mehar |
| author_sort | Pasha Normahani |
| collection | DOAJ |
| description | Introduction Diabetic foot ulceration (DFU) is a common and challenging complication of diabetes. Risk stratification can guide further management. We aim to evaluate the prognostic performance of bedside tests used for peripheral arterial disease (PAD) diagnosis to predict DFU healing.Research design and methods Testing for Arterial Disease in Diabetes (TrEAD) was a prospective observational study comparing the diagnostic performance of commonly used tests for PAD diagnosis. We performed a secondary analysis assessing whether these could predict DFU healing. Follow-up was performed prospectively for 12 months. The primary outcome was sensitivity for predicting ulcer healing. Secondary endpoints were specificity, predictive values, and likelihood ratios for ulcer healing.Results 123 of TrEAD participants with DFU were included. In 12 months, 52.8% of ulcers healed. The best negative diagnostic likelihood ratio (NDLR) was observed for the podiatry ankle duplex scan (PAD-scan) monophasic or biphasic with adverse features(NDLR 0.35, 95% CI 0.14–0.90). The highest positive likelihood ratios were observed for toe brachial pressure index of ≤0.2 (positive diagnostic likelihood ratio (PDLR) 7.67, 95% CI 0.91–64.84) and transcutaneous pressure of oxygen of ≤20 mm Hg (PDLR 2.68, 95% CI 0.54–13.25). Cox proportional hazards modeling demonstrated significantly greater probabilities of healing with triphasic waveforms (HR=2.54, 95% CI 1.23–5.3, p=0.012) and biphasic waveforms with non-adverse features (HR=13.67, 95% CI 4.78–39.1, p<0.001) on PAD-scan.Conclusions No single test performed well enough to be used in isolation as a prognostic marker for the prediction of DFU healing.Trial registration number NCT04058626. |
| first_indexed | 2024-03-12T21:28:44Z |
| format | Article |
| id | doaj.art-8be06f70b99f4576bd1371921e96b1c5 |
| institution | Directory Open Access Journal |
| issn | 2052-4897 |
| language | English |
| last_indexed | 2024-03-12T21:28:44Z |
| publishDate | 2023-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj.art-8be06f70b99f4576bd1371921e96b1c52023-07-28T00:30:07ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972023-04-0111210.1136/bmjdrc-2022-003110Evaluating the prognostic performance of bedside tests used for peripheral arterial disease diagnosis in the prediction of diabetic foot ulcer healingPasha Normahani0Usman Jaffer1Alun H Davies2Viknesh Sounderajah3Hussein Elghazaly4Theodore Howard5Sharan Sanjay6Omer G Mohamed7Zaheer Mehar8Vascular Unit, Imperial College Healthcare NHS Trust, London, UK2 Imperial Vascular Unit, Imperial College NHS Healthcare Trust, London, UKDepartment of Surgery and Cancer, Imperial College London, London, UKclinical research fellow, Institute of Global Health Innovation1 Section of Vascular Surgery, Imperial College London, London, UK2 Imperial Vascular Unit, Imperial College NHS Healthcare Trust, London, UK2 Imperial Vascular Unit, Imperial College NHS Healthcare Trust, London, UK2 Imperial Vascular Unit, Imperial College NHS Healthcare Trust, London, UK3 Department of Vascular Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UKIntroduction Diabetic foot ulceration (DFU) is a common and challenging complication of diabetes. Risk stratification can guide further management. We aim to evaluate the prognostic performance of bedside tests used for peripheral arterial disease (PAD) diagnosis to predict DFU healing.Research design and methods Testing for Arterial Disease in Diabetes (TrEAD) was a prospective observational study comparing the diagnostic performance of commonly used tests for PAD diagnosis. We performed a secondary analysis assessing whether these could predict DFU healing. Follow-up was performed prospectively for 12 months. The primary outcome was sensitivity for predicting ulcer healing. Secondary endpoints were specificity, predictive values, and likelihood ratios for ulcer healing.Results 123 of TrEAD participants with DFU were included. In 12 months, 52.8% of ulcers healed. The best negative diagnostic likelihood ratio (NDLR) was observed for the podiatry ankle duplex scan (PAD-scan) monophasic or biphasic with adverse features(NDLR 0.35, 95% CI 0.14–0.90). The highest positive likelihood ratios were observed for toe brachial pressure index of ≤0.2 (positive diagnostic likelihood ratio (PDLR) 7.67, 95% CI 0.91–64.84) and transcutaneous pressure of oxygen of ≤20 mm Hg (PDLR 2.68, 95% CI 0.54–13.25). Cox proportional hazards modeling demonstrated significantly greater probabilities of healing with triphasic waveforms (HR=2.54, 95% CI 1.23–5.3, p=0.012) and biphasic waveforms with non-adverse features (HR=13.67, 95% CI 4.78–39.1, p<0.001) on PAD-scan.Conclusions No single test performed well enough to be used in isolation as a prognostic marker for the prediction of DFU healing.Trial registration number NCT04058626.https://drc.bmj.com/content/11/2/e003110.full |
| spellingShingle | Pasha Normahani Usman Jaffer Alun H Davies Viknesh Sounderajah Hussein Elghazaly Theodore Howard Sharan Sanjay Omer G Mohamed Zaheer Mehar Evaluating the prognostic performance of bedside tests used for peripheral arterial disease diagnosis in the prediction of diabetic foot ulcer healing BMJ Open Diabetes Research & Care |
| title | Evaluating the prognostic performance of bedside tests used for peripheral arterial disease diagnosis in the prediction of diabetic foot ulcer healing |
| title_full | Evaluating the prognostic performance of bedside tests used for peripheral arterial disease diagnosis in the prediction of diabetic foot ulcer healing |
| title_fullStr | Evaluating the prognostic performance of bedside tests used for peripheral arterial disease diagnosis in the prediction of diabetic foot ulcer healing |
| title_full_unstemmed | Evaluating the prognostic performance of bedside tests used for peripheral arterial disease diagnosis in the prediction of diabetic foot ulcer healing |
| title_short | Evaluating the prognostic performance of bedside tests used for peripheral arterial disease diagnosis in the prediction of diabetic foot ulcer healing |
| title_sort | evaluating the prognostic performance of bedside tests used for peripheral arterial disease diagnosis in the prediction of diabetic foot ulcer healing |
| url | https://drc.bmj.com/content/11/2/e003110.full |
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