title: A targeted screening method for non-invasive vascular assessment of the lower limb.
abstract: BACKGROUND
  Podiatrists routinely perform non-invasive lower limb vascular assessment, however frequently cite time as a major barrier in performing regular assessment. The aim of this study was to develop an evidence-based vascular assessment method to guide podiatrists' decision-making processes to aid in timely vascular assessment in at risk populations.
  
  
  METHODS
  The sample underwent brachial pressure measurement, ankle pressures, toe pressure and Doppler waveform with colour duplex ultrasound (CFDU) used as the reference standard. Both the targeted screening method and the American Heart Association (AHA) guideline for vascular screening were then applied to the data set and sensitivity and specificity of each method was calculated.
  
  
  RESULTS
  One hundred nineteen participants were included. Sensitivity of the targeted screening method (62%, 95% CI 47.17-75.35) was higher than the AHA method (49%, 95% CI 34.75-63.40), however, specificity of the AHA method (94%, 95% CI 85.62-98.37) was higher than the targeted screening method (85%, 95% CI 74.26-92.60). Diagnostic accuracy was similar with the AHA method yielding 74% diagnostic accuracy and the targeted screening method 73%.
  
  
  CONCLUSIONS
  The targeted screening method and the broad international guideline demonstrated similar accuracy, however clinicians may save time using the targeted screening method. This study highlights the difficulties in obtaining accuracy in lower limb vascular assessment in general.
authors.affiliation: School of Health Sciences, Faculty of Health, University of Newcastle, Ourimbah, NSW 2258 Australia.
authors.forename: Peta Ellen
authors.initials: PE
authors.lastname: Tehan
authors.affiliation: School of Health Sciences, Faculty of Health, University of Newcastle, Ourimbah, NSW 2258 Australia.
authors.forename: Vivienne Helaine
authors.initials: VH
authors.lastname: Chuter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D001794:Blood Pressure / Q000502:physiology; D001916:Brachial Artery / Q000503:physiopathology; D000066491:Clinical Decision-Making / Q000379:methods; D019317:Evidence-Based Medicine / Q000379:methods; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014034:Toes / Q000098:blood supply; D018615:Ultrasonography, Doppler, Color / Q000379:methods; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods
keywords: Non-invasive vascular assessment; Podiatrist