长期以来,踝臂压指数(ABPI)测量一直被认为是下肢溃疡患者血管评估的金标准。尽管如此,在英国,只有约15%需要进行ABPI测量的患者接受了评估.Lanarkshire血氧测定指数(LOI)是一种更便宜,更容易获得的血管评估方法,最初于2000年被提议作为ABPI的替代方法。自从将LOI引入文献以来,尚未进行与LOI相关的证据的合成。寻求初步研究以确定LOI的临床特性及其与ABPI评估的一致性水平。系统搜索MEDLINE,CINAHL,Cochrane中央控制试验登记册,BNI,ProQuest健康与医学,科学直接,进行了GoogleScholar和大英图书馆(在线搜索)。还审查了已确定研究的参考列表,以确定其他研究。三项主要研究符合纳入标准,使用LOI和ABPI评估的307例患者和584条肢体的报告数据.所有三项研究均报告了评估者间可靠性的中等至中等kappa值(κ=0.290-0.747)以及LOI和ABPI之间的统计学显着正相关系数(r=0.37,在两项研究中p<0.001)。三项研究的综合数据表明,使用ABPI作为参考,LOI的敏感性为52%(41.78-62.1,95%置信区间[CI])和特异性为96.08%(93.4-97.9,95%CI)。需要额外的数据来表明LOI在实践中的安全性。还需要数据来确定与ABPI相比,LOI是否更容易被临床医生接受,以及在实践中实施LOI是否存在任何障碍/促成因素。鉴于LOI的特异性相对较低,将LOI的测量与主观临床风险评估工具相结合,以提高这种替代血管评估方法的敏感性可能是有益的.
Ankle Brachial Pressure Index (ABPI) measurement has long been considered the gold standard of vascular assessment for people with lower limb ulceration. Despite this, only around 15% of patients in the United Kingdom who require an ABPI measurement undergo the assessment. The Lanarkshire Oximetry Index (LOI) is a cheaper and arguably more accessible approach to vascular assessment and was initially proposed as an alternative to the ABPI in 2000. No synthesis of evidence related to the
LOI has been performed since its introduction into the literature. Primary studies were sought to determine the clinimetric properties of the
LOI and its level of agreement with ABPI assessments. Systematic searches of MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, BNI, ProQuest Health and Medicine, Science Direct, Google Scholar and the British Library (online search) were conducted. Reference lists of identified studies were also reviewed to identify additional studies. Three primary studies met the inclusion criteria, reporting data from 307 patients and 584 limbs assessed using both the LOI and ABPI. All three studies reported fair to moderate kappa values for interrater reliability (κ = 0.290-0.747) and statistically significant positive correlation coefficients (r = 0.37, p < 0.001 in two studies) between the LOI and ABPI. The combined data from the three studies indicated a sensitivity of 52% (41.78-62.1, 95% confidence interval [CI]) and specificity of 96.08% (93.4-97.9, 95% CI) for the LOI using the ABPI as a reference. Additional data are required to indicate the safety of the
LOI in practice. Data are also required to determine if the
LOI is more acceptable to clinicians compared to the ABPI and whether there are any barriers/enablers to its implementation in practice. Given the relatively low specificity of the
LOI, it may be beneficial to combine measurement of the
LOI with a subjective clinical risk assessment tool to improve the sensitivity of this alternative approach to vascular assessment.