Abstract
Objectives
There are limited non-invasive methods to assess lower extremity arterial injuries
in the emergency department (ED) and pre-hospital setting. The ankle-brachial index
(ABI) requires careful auscultation by Doppler, an approach made difficult in noisy
environments. We sought to determine the agreement of the ABI measured using the pulse
oximeter plethysmograph waveform (Pleth) with auscultation by Doppler in a controlled
setting. A secondary outcome sought to examine the agreement of ABI by automated oscillometric
sphygmomanometer (AOS) with Doppler.
Methods
We measured blood pressure in the right upper and lower extremities of healthy volunteers
using: (1) Doppler and manual sphygmomanometer; (2) Pleth and manual sphygmomanometer;
and (3) AOS. The Bland-Altman approach to assessing agreement between methods was
used comparing mean differences between ABI pairs to their means for Doppler versus
Pleth and Doppler versus AOS. The intraclass correlation coefficient (ICC) from mixed
effects models examined intra- and inter-rater reliability.
Results
Among 100 participants with normal ABI the mean ABI (95%CI) were Doppler 1.11 (0.90–1.33),
Pleth 1.10 (0.91–1.30), and AOS 1.10 (0.90–1.30). The ABI difference (95% CI for limits
of agreement) were 0.01 (−0.20,0.18) for Doppler-Pleth and 0.02 (−0.26, 0.22) for
Doppler-AOS. The ICC for the Doppler-Pleth comparison (ICC = 0.56, 95% CI 0.47–0.63)
was greater than for the Doppler-AOS (ICC = 0.32, 95% CI 0.19–0.43).
Conclusions
The ABI measured using the Pleth has a high level of agreement with measurement by
Doppler. The AOS and Doppler have good agreement with greater measurement variability.
Pleth and AOS may be reasonable alternatives to Doppler for ABI.
Keywords
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Article Info
Publication History
Published online: October 27, 2020
Accepted:
October 23,
2020
Received in revised form:
October 18,
2020
Received:
May 28,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
