title: Audible handheld Doppler ultrasound determines reliable and inexpensive exclusion of significant peripheral arterial disease.
abstract: OBJECTIVE
  To determine the accuracy of audible arterial foot signals with an audible handheld Doppler ultrasound for identification of significant peripheral arterial disease as a simple, quick, and readily available bedside screening tool.
  
  
  METHODS
  Two hundred consecutive patients referred to an interprofessional wound care clinic underwent audible handheld Doppler ultrasound of both legs. As a control and comparator, a formal bilateral lower leg vascular study including the calculation of Ankle Brachial Pressure Index and toe pressure (TP) was performed at the vascular lab. Diagnostic reliability of audible handheld Doppler ultrasound was calculated versus Ankle Brachial Pressure Index as the gold standard test.
  
  
  RESULTS
  A sensitivity of 42.8%, a specificity of 97.5%, negative predictive value of 94.10%, positive predictive value of 65.22%, positive likelihood ratio of 17.52, and negative likelihood ratio of 0.59. The univariable logistic regression model had an area under the curve of 0.78. There was a statistically significant difference at the 5% level between univariable and multivariable area under the curves of the dorsalis pedis and posterior tibial models (p < 0.001).
  
  
  CONCLUSIONS
  Audible handheld Doppler ultrasound proved to be a reliable, simple, rapid, and inexpensive bedside exclusion test of peripheral arterial disease in diabetic and nondiabetic patients.
authors: Department of Medicine (Dermatology), University of Toronto, Canada afsaneh.alavi@utoronto.ca.
authors: Afsaneh
authors: A
authors: Alavi
authors: Department of Medicine (Dermatology), University of Toronto, Canada Mississauga Wound Clinic, Toronto, Canada.
authors: R Gary
authors: RG
authors: Sibbald
authors: Medical College of Virginia at Virginia Commonwealth University, USA.
authors: Reza
authors: R
authors: Nabavizadeh
authors: Virginia Commonwealth University School of Dentistry, USA.
authors: Farnaz
authors: F
authors: Valaei
authors: Mississauga Wound Clinic, Toronto, Canada.
authors: Pat
authors: P
authors: Coutts
authors: University Hospital of Zurich, Switzerland.
authors: Dieter
authors: D
authors: Mayer
mesh_terms: D000161:Acoustic Stimulation; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D019540:Area Under Curve; D001307:Auditory Perception; D003362:Cost-Benefit Analysis; D004867:Equipment Design; D005260:Female; D017048:Health Care Costs; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging* / Q000191:economics / Q000503:physiopathology; D019095:Point-of-Care Systems; D000067716:Point-of-Care Testing; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler / Q000191:economics / Q000295:instrumentation*
keywords: Peripheral arterial disease; ankle brachial index; audible Doppler; compression therapy; leg ulcers; standard test