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Inadequacies of Physical Examination in Patients with Acute Lower Limb Ischemia Are Associated with Dreadful
Andrea Kulezic1, Martin Macek1, Stefan Acosta2
1Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
Insights
Accurate diagnosis of acute lower limb ischemia (ALI) is crucial. Better clinical examinations in ALI patients are linked to reduced amputation and mortality risks at one year.
Area of Science:
- Vascular Surgery
- Emergency Medicine
- Clinical Diagnostics
Background:
- Acute lower limb ischemia (ALI) presents a significant threat to limb and life.
- Adherence to diagnostic guidelines for ALI impacts patient outcomes.
- This study investigates the link between clinical examination quality and ALI patient prognosis.
Purpose of the Study:
- To explore the association between the quality of clinical diagnosis in acute lower limb ischemia (ALI) and patient outcomes at one year.
- To determine if adherence to diagnostic guidelines for ALI correlates with reduced major amputation or mortality.
- To assess the effectiveness of a standardized bedside evaluation scoring system for ALI.
Main Methods:
- A retrospective cohort study analyzed 161 patients with ALI from 2015-2018.
- A bedside evaluation scoring system (0-7) based on the 6 'Ps' and Ankle-Brachial Index (ABI) was used.
- Multivariate logistic regression analyzed the association between examination scores and 1-year outcomes, adjusting for confounders.
Main Results:
- A satisfactory initial clinical examination (score ≥5) was achieved in 55.3% of ALI patients.
- Key diagnostic elements like ABI measurement, pulse assessment, paralysis evaluation, and a bedside score ≥5 were linked to lower amputation/mortality risk.
- Specific findings: ABI measurement (OR 0.25), complete pulse status (OR 0.41), paralysis evaluation (OR 0.43), and bedside score ≥5 (OR 0.48) showed significant associations.
Conclusions:
- The quality of initial bedside evaluations for ALI is frequently unsatisfactory.
- Improved clinical diagnostic skills in ALI are associated with better patient outcomes at one year.
- Enhancing clinical diagnostics for ALI is essential to improve patient prognosis and reduce adverse events.
Background:
Acute lower limb ischemia (ALI) is limb and life-threatening. The aim of this study was to explore the association between adherence to guidelines on clinical diagnosis of ALI and outcome at 1 year. The hypothesis was that that better examination was associated with favorable outcome in ALI patients.
Methods:
Retrospective cohort study between 2015 and 2018. In-hospital, operation, radiological and autopsy registries captured 161 citizens of Malmö with ALI. The initial bedside evaluation was performed by an emergency physician. Scoring was based on evaluation of the 6 "Ps" and 1 point was given for pain, pallor, pulselessness, perishing cold, paresthesia, paralysis or ankle-brachial pressure index (ABI). The performance was scored (range 0-7), and a score ≥5 was defined as a satisfactory vascular leg status. A multivariate logistic regression was performed to adjust for confounders and expressed in Odds Ratios (OR) with 95% confidence intervals (CI).
Results:
A satisfactory first clinical examination was performed in 55.3% of the patients. Measurement of ABI (OR 0.25, 95% CI 0.11-0.55), performing complete pulse status (OR 0.41, 95% CI 0.20-0.85), evaluating paralysis (OR 0.43, 95% CI 0.20-0.89), and a bedside score ≥5 points (OR 0.48, 95% CI 0.23-0.97) were independently associated with reduced risk of major amputation/mortality at 1-year follow up.
Conclusions:
Quality of initial bedside evaluation in patients with ALI was unsatisfactory to a large extent and better clinical examinations were associated with favorable outcome at 1 year. Skills in clinical diagnostics in ALI needs to be much improved.
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