Symptomatic peripheral arterial disease: the value of a validated questionnaire and a clinical decision rule.
BACKGROUND
If a validated questionnaire, when applied to patients reporting with symptoms of intermittent claudication, could adequately discriminate between those with and without peripheral arterial disease, GPs could avoid the diagnostic measurement of the ankle brachial index.


OBJECTIVE
To investigate the Edinburgh Claudication Questionnaire (ECQ) in general practice and to develop a clinical decision rule based on risk factors to enable GPs to easily assess the likelihood of peripheral arterial disease.


METHODS
An observational study.


METHODS
General practice in The Netherlands.


METHODS
This observational study included patients of > or =55 years visiting their GP for symptoms suggestive of intermittent claudication or with one risk factor. The ECQ and the ankle brachial index were performed. The prevalence of peripheral arterial disease, defined as an ankle brachial index <0.9, was related to risk factors using logistic regression analyses, on which a clinical decision rule was developed and related to the presence of peripheral arterial disease.


RESULTS
Of the 4790 included patients visiting their GP with symptoms suggestive of intermittent claudication, 4527 were eligible for analyses. The prevalence of peripheral arterial disease in this group was 48.3%. The sensitivity of the ECQ was only 56.2%. The prevalence of peripheral arterial disease in a clinical decision rule that included age, male sex, smoking, hypertension, hypercholesterolemia, and a positive ECQ, increased from 14% in the lowest to 76% in the highest category.


CONCLUSIONS
This study indicates that the ECQ alone has an inadequate diagnostic value in detecting patients with peripheral arterial disease. The ankle brachial index should be performed to diagnose peripheral arterial disease in patients with complaints suggestive of intermittent claudication, although our clinical decision rule could help to differentiate between extremely high and lower prevalence of peripheral arterial disease.
Bendermacher
Bianca Lw
BL
Department of Surgery, Atrium Medical Centre, Heerlen, The Netherlands.
Teijink
Joep Aw
JA
Willigendael
Edith M
EM
Bartelink
Marie-Louise
ML
Büller
Harry R
HR
Peters
Ron Jg
RJ
Boiten
Jelis
J
Langenberg
Machteld
M
Prins
Martin H
MH
D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000098:blood supply*; D001794:Blood Pressure; D001795:Blood Pressure Determination; D001916:Brachial Artery / Q000502:physiology*; D003657:Decision Making; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000175:diagnosis; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D011795:Surveys and Questionnaires