Evaluating the prognostic performance of bedside tests used for peripheral arterial disease diagnosis in the prediction of diabetic foot ulcer healing

Abstract

IntroductionDiabetic 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 methodsTesting 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.Results123 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.ConclusionsNo single test performed well enough to be used in isolation as a prognostic marker for the prediction of DFU healing.Trial registration numberNCT04058626.

Prevalence and risk factors for diabetic foot complications among people living with diabetes in Harare, Zimbabwe: a cross-sectional study

“…The prevalence of peripheral neuropathy and PAD reported in this study are significantly greater than those recorded in the USA (6% and 9.5% respectively), possibly because of the lack of foot screening services in Zimbabwe [ 44 , 45 ]. Evidence of the impact of regular foot screening for reducing DF has been widely published, including in an Australian study that confirmed that non-indigenous people who frequently visited the clinic and received regular foot screening had a lower prevalence of DF than indigenous people who had poor health-seeking behaviours and limited resources in their community health facilities [ 30 , 46 ].…”