JDM  Vol.3 No.2 , May 2013
Use of pocket pulse oximeters for detecting peripheral arterial disease in patients with diabetes mellitus
Abstract: Recent Aims: New diagnostic methods are needed to detect peripheral arterial disease easier than using the ankle-brachial index measured by Doppler devices. We investigated whether the use of pocket pulse oximeters could meet sensitivity and specificity criteria as screening method to detect significant peripheral arterial perfusion deficits. Methods: We measured oxygen saturation (SaO2) at index fingers and great toes (on horizontal and elevated 30°) by a pocket pulse oximeter in 250 subjects with diabetes mellitus attending the outpatient clinic. A finger-to-toe SaO2 gradient greater than 2% was considered abnormal. Ankle-brachial index was measured by a hand held Doppler device. Peripheral arterial disease was defined as an ankle-brachial index less than 0.9. Results: A total of 1392 (93%) valid SaO2 readings were obtained. Twenty-seven (11%) patients were excluded due to not having measurable SaO2 finger-to-toe gradients. A total of 223 patients were analyzed. Peripheral arterial disease was detected in 47 (21%) patients. A finger-to-toe SaO2 gradient greater than 2% had sensitivity 42.6% (95% CI 30.0% - 55.3%), specificity 79.1% (95% CI 75.7% - 82.6%), positive predictive value 35.7% (95% CI 25.2% - 46.4%), negative predictive value 83.4% (95% CI 79.8 - 87.1), positive likelihood ratio 2.03 (95% CI 1.23 - 3.17) and negative likelihood ratio 0.73 (95% CI 0.54 - 0.93) to detect peripheral arterial disease. The area under the receiving operating characteristic curve was 0.69 (95% CI 0.62 - 0.77). Conclusion: Pocket pulse oximeters showed insufficient sensitivity as screening method for detecting peripheral arterial disease in patients with diabetes mellitus.
Cite this paper: Ena, J. , Argente, C. , González-Sánchez, V. , Algado, N. , Verdú, G. and Lozano, T. (2013) Use of pocket pulse oximeters for detecting peripheral arterial disease in patients with diabetes mellitus. Journal of Diabetes Mellitus, 3, 79-85. doi: 10.4236/jdm.2013.32012.

[1]   Global Lower Extremity Amputation Study Group. (2000) Epidemiology of lower extremity amputation in centres in Europe, North America and East Asia. British Journal of Surgery, 87, 328-337. doi:10.1046/j.1365-2168.2000.01344.x

[2]   Boulton, A.J., Armstrong, D.G., Albert, S.F., Frykberg, R.G., Hellman, R., Kirkman, M.S., Lavery, L.A., LeMaster, J.W., Mills Sr., J.L., Mueller, M.J., Sheehan, P. and Wukich, D.K. (2008) Comprehensive foot examination and risk assessment. A report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Physical Therapy, 88, 1436-1443.

[3]   Tendera, M., Aboyans, V., Bartelink, M.L., Baumgartner, I., Clément, D., Collet, J.P., Cremonesi, A., De Carlo, M., Erbel, R., Fowkes, F.G., Heras, M., Kownator, S., Minar, E., Ostergren, J., Poldermans, D., Riambau, V., Roffi, M., R?ther, J., Sievert, H., van Sambeek, M., Zeller, T. (2011) Esc guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: The Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). European Heart Journal, 32, 2851-906. doi:10.1093/eurheartj/ehr211

[4]   Rooke, T.W., Hirsch, A.T., Misra, S., Sidawy, A.N., Beckman, J.A., Findeiss, L.K., Golzarian, J., Gornik, H.L., Halperin, J.L., Jaff, M.R., Moneta, G.L., Olin, J.W., Stanley, J.C., White, C.J., White, J.V., Zierler, R.E. (2011) 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (updating the 2005 guideline): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of American College of Cardiologiy, 58, 2020-2045. doi:10.1016/j.jacc.2011.08.023

[5]   Gregg, E.W., Sorlie, P., Paulose-Ram, R., Gu, Q., Eberhardt, M.S., Wolz, M., Burt, V., Curtin, L., Engelgau, M. and Geiss, L. (2004) Prevalence of lower-extremity disease in the US adult population ≥40 years of age with and without diabetes: 1999-2000 national health and nutrition examination survey. Diabetes Care, 27, 1591-1597. doi:10.2337/diacare.27.7.1591

[6]   Grenon, S.M., Gagnon, J. and Hsiang, Y. (2009) Anklebrachial index for assessment of peripheral arterial disease. New England Journal of Medicine, 361, e40. doi:10.1056/NEJMvcm0807012

[7]   Parameswaran, G.I., Brand, K. and Dolan, J. (2005) Pulse oximetry as a potential screening tool for lower extremity arterial disease in asymptomatic patients with diabetes mellitus. Archives of Internal Medicine, 165, 442-446. doi:10.1001/archinte.165.4.442

[8]   Bossuyt, P.M., Reitsma, J.B., Bruns, D.E., Gatsonis, C.A., Glasziou, P.P., Irwig, L.M., Moher, D., Rennie, D., de Vet, H.C. and Lijmer, J.G. (2003) The STARD statement for reporting studies of diagnostic accuracy: Explanation and elaboration. Clinical Chemistry, 49, 7-18. doi:10.1373/49.1.7

[9]   Leng, G.C. and Fowkes, F.G. (1992) The Edinburgh Claudication Questionnaire: An improved version of the WHO/Rose Questionnaire for use in epidemiological surveys. Journal of Clinical Epidemiology, 45, 1101-1109. doi:10.1016/0895-4356(92)90150-L

[10]   Fowkes, F.G. (1988) The measurement of atherosclerotic peripheral arterial disease in epidemiological surveys. International Journal of Epidemiology, 17, 248-254. doi:10.1093/ij e/17.2.248

[11]   Arkin, C.F. and Wachtel, M.S. (1990) How many patients are necessary to assess test performance. Journal of American Medical Association, 263, 275-278.

[12]   Akram, J., Aamir, A.U., Basit, A., Qureshi, M.S., Mehmood, T., Shahid, S.K., Khoso, I.A., Ebrahim, M.A. and Omair. A. (2011) Prevalence of peripheral arterial disease in type 2 diabetics in Pakistan. Journal of Pakistan Medical Association, 61, 644-648.

[13]   Walters, D.P., Gatling, W., Mullee, M.A. and Hill, R.D. (1992) The prevalence, detection, and epidemiological correlates of peripheral vascular disease: A comparison of diabetic and non-diabetic subjects in an English community. Diabetic Medicine, 9, 710-715. doi:10.1111/j.1464-5491.1992.tb01878.x

[14]   Joyce, W.P., Walsh, K., Gough, D.B., Gorey, T.F. and Fitzpatrick, J.M. (1990) Pulse oximetry: A new non-invasive assessment of peripheral arterial occlusive disease. British Journal of Surgery, 77, 1115-1117. doi:10.1002/bjs.1800771013

[15]   Ignjatovic, N., Vasiljevic, M., Milic, D., Stefanovic, J., Stojanovic, M., Karanikolic, A., Zlatic, A., Djordjevic, G., Zivic, S., Jeremic, L., Djordjevic, I. and Jankovic, R. (2010) Diagnostic importance of pulse oximetry in the determination of the stage of chronic arterial insufficiency of lower extremities. Srpski Arhiv Za Celokupno Lekarstvo, 138, 300-304. doi:10.2298/SARH1006300I

[16]   Jawahar, D., Rachamalla, H.R., Rafalowski, A., Ilkhani, R., Bharathan, T. and Anandarao, N. (1997) Pulse oximetry in the evaluation of peripheral vascular disease. Angiology, 48, 721-724. doi:10.1177/000331979704800808

[17]   Couse, N.F., Delaney, C.P., Horgan, P.G., O’Keeffe, J., Joyce, W.P., Gorey, T.F., Fitzpatrick, J.M. (1994) Pulse oximetry in the diagnosis of non-critical peripheral vascular insufficiency. Journal of the Royal Society of Medicine, 87, 511-512.

[18]   Jude, E.B., Eleftheriadou. I. and Tentolouris. N. (2010) Peripheral arterial disease in diabetes—A review. Diabetic Medicine, 27, 4-14. doi:10.1111/j.1464-5491.2009.02866.x

[19]   Leskinen, Y., Salenius, J.P., Letimaki, T., Huhtala, H. and Saha, H. (2002) The prevalence of peripheral arterial disease and medial arterial calcification in patients with chronic renal failure: Requirements for diagnostics. American Journal of Kidney Diseases, 40, 472-479. doi:10.1053/ajkd.2002.34885

[20]   Takahara, M., Kaneto, H., Iida, O., Katakami, N., Matsuoka, T., Ikeda, M., et al. (2012) Association of diabetes and hemodialysis with ankle pressure and ankle-brachial index in Japanese patients with critical limb ischemia. Diabetes Care, 35, 2000-2004. doi:10.2337/dc11-1636