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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


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


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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