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INTERNATIONAL ANGIOLOGY

A Journal on Angiology


Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 1999 September;18(3):220-4

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Inter-observer variation. An alternative method of assessing the role of ultrasonic imaging in clinical decision-making in lower limb arterial disease

Aly S., Shoab S., Bishop Ch.

From the Department of Surgery, University College London Medical School, London, Great Britain


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Background. The aim of the study is to deter­mine the role of ­duplex scan­ning in deciding on the final treat­ment for ­patients with lower limb arte­ri­al dis­ease com­pared to intra-arte­ri­al dig­i­tal sub­trac­tion arter­i­og­ra­phy (IA DSA).
Methods. Eighty-two ­patients (55 males, 27 ­females, mean age 68 years) with lower limb arte­ri­al dis­ease had both ­duplex and arter­i­og­ra­phy per­formed. The find­ings of both modal­ities were report­ed by sonog­ra­pher and radio-l­o­gist in 164 anon­y­mous ­reports. Five vas­cu­lar sur­geons (con­sul­tant grade) were asked to plan their treat­ment on the data pro­vid­ed in these ­reports. For the pur­pos­es of sta­tis­ti­cal anal­y­sis, the actu­al treat­ment the ­patient ­received was used as the ref­er­ence stan­dard. Both ­reports and treat­ment deci­sions were coded (dou­ble blind­ed).
Results. The over­all accu­ra­cy of ­duplex scan­ning to ­assess arte­ri­al dis­ease of the lower limbs ­showed a sen­si­tiv­ity of 92%, and spec­i­fic­ity of 99%. The accu­ra­cy of the deci­sions based on ­duplex was 84% and kappa with k of 0.62 (95% CI+0.14) com­pared to the ref­er­ence stan­dard, while the accu­ra­cy of the deci­sion based on arter­i­og­ra­phy was 85% and kappa 0.63 (95% CI+0.14). The accu­ra­cy of deci­sions based on ­duplex com­pared to those based on arter­i­og­ra­phy (arter­i­og­ra­phy used as ref­er­ence stan­dard) was 91% and a kappa of 0.77 (95% CI+0.14).
Conclusions. Duplex scan­ning is an accu­rate diag­nos­tic modal­ity, and clin­i­cal deci­sions can be safe­ly based on its find­ings.

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