Inadequacies of Physical Examination in Patients with Acute Lower Limb Ischemia Are Associated with Dreadful Consequences
Kulezic, Andrea LU ; Macek, Martin and Acosta, Stefan LU
(2022)
In Annals of Vascular Surgery
82.
p.190-196
- Abstract
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... (More)
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.
(Less)
- author
- Kulezic, Andrea
LU
; Macek, Martin
and Acosta, Stefan
LU
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Annals of Vascular Surgery
- volume
- 82
- pages
- 190 - 196
- publisher
- Springer
- external identifiers
-
- scopus:85123900703
- pmid:34902465
- ISSN
- 0890-5096
- DOI
- 10.1016/j.avsg.2021.10.067
- language
- English
- LU publication?
- yes
- id
- beeee018-caa8-4182-9c6f-06106372296f
- date added to LUP
- 2022-04-12 16:49:16
- date last changed
- 2024-04-21 19:37:09
@article{beeee018-caa8-4182-9c6f-06106372296f,
abstract = {{<p>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.</p>}},
author = {{Kulezic, Andrea and Macek, Martin and Acosta, Stefan}},
issn = {{0890-5096}},
language = {{eng}},
pages = {{190--196}},
publisher = {{Springer}},
series = {{Annals of Vascular Surgery}},
title = {{Inadequacies of Physical Examination in Patients with Acute Lower Limb Ischemia Are Associated with Dreadful Consequences}},
url = {{http://dx.doi.org/10.1016/j.avsg.2021.10.067}},
doi = {{10.1016/j.avsg.2021.10.067}},
volume = {{82}},
year = {{2022}},
}