An Iranian scoring system for diagnosing Buerger's disease

Area of Science:

• Vascular Medicine
• Medical Diagnostics
• Epidemiology

Background:

• Buerger's disease (thromboangiitis obliterans) is prevalent in Iran.
• Existing diagnostic criteria may not fully capture the disease's presentation in the Iranian population.

Purpose of the Study:

• To evaluate clinical manifestations and risk factors of Buerger's disease in an Iranian cohort.
• To propose and validate novel diagnostic criteria for Buerger's disease.
• To compare the proposed criteria with the established Papa criteria.

Main Methods:

• A cross-sectional study involving 122 patients (61 with Buerger's disease, 61 controls) referred to Sina Hospital's Vascular Clinic (2009-2011).
• Clinical data, including symptoms (resting limb pain, ischemic ulcers, intermittent claudication) and risk factors, were collected.
• Multivariate regression analyses were used to develop and validate diagnostic criteria.

Main Results:

• Key indicators for Buerger's disease included absent pulsation (95.1%), abnormal distal Doppler sonography (95.1%), and ischemic ulcers (80.3%).
• The developed criteria, incorporating age, sex, smoking, Raynaud's phenomenon, abnormal proximal Doppler, diabetes mellitus, and hyperlipidemia, achieved 95.1% sensitivity and 78.7% specificity (R²=0.582).
• The proposed criteria showed good agreement with Papa criteria (Kappa=0.66, P<0.001).

Conclusions:

• The study suggests new, accurate diagnostic criteria for Buerger's disease, particularly relevant for the Iranian population.
• The developed criteria demonstrate acceptable accuracy and may aid in more precise diagnosis.
• Further validation with larger, diverse populations is recommended.