Accuracy of the general practitioner’s sense of alarm when confronted with dyspnoea and/or chest pain: a prospective observational study

ObjectivesDyspnoea and chest pain are symptoms shared with multiple pathologies ranging from the benign to life-threatening diseases. A Gut Feelings Questionnaire (GFQ) has been validated to measure the general practitioner’s (GPs) sense of alarm or sense of reassurance. The aim of the study was to estimate the diagnostic test accuracy of GPs’ sense of alarm when confronted with dyspnoea and chest pain.Design and settingsProspective observational study in general practice.ParticipantsPatients aged between 18 and 80 years, consulting their GP for dyspnoea and/or chest pain, were considered for enrolment. These GPs had to complete the GFQ immediately after the consultation.Primary outcome measuresLife-threatening and non-life-threatening diseases have previously been defined according to the pathologies or symptoms in the International Classification of Primary Care (ICPC)-2 classification. The index test was the sense of alarm and the reference standard was the final diagnosis at 4 weeks.Results25 GPs filled in 235 GFQ questionnaires. The positive likelihood ratio for the sense of alarm was 2.12 (95% CI 1.49 to 2.82), the negative likelihood ratio was 0.55 (95% CI 0.37 to 0.77).ConclusionsWhere the physician experienced a sense of alarm when a patient consulted him/her for dyspnoea and/or chest pain, the post-test odds that this patient had, in fact, a life-threatening disease was about twice as high as the pretest odds.Trial registration numberNCT02932982.

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Clinical judgement of General Practitioners for the diagnosis of dementia

10.1101/2020.11.20.20234062 ◽

2020 ◽

Author(s):

Sam Creavin ◽

Judy Haworth ◽

Mark Fish ◽

Sarah Cullum ◽

Antony Bayer ◽

...

Keyword(s):

Likelihood Ratio ◽

General Practitioners ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Clinical Judgement ◽

Test Accuracy ◽

Index Test ◽

Duration Of Symptoms ◽

Diagnosis Of Dementia ◽

Gp Index

Background: The accuracy of General Practitioners' (GPs') clinical judgement for diagnosing dementia is uncertain. Aim: Investigate the accuracy of GPs' clinical judgement for the diagnosis of dementia. Design and Setting: Diagnostic test accuracy study, recruiting from 21 practices around Bristol. Method: The clinical judgement of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged over 70 years who had symptoms of possible dementia. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to ICD-10 criteria for dementia. Results: 240 people were recruited, with a median age of 80 years (IQR 75 to 84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12 to 36 months) and the median ACE-III score was 75 (IQR 65 to 87). GP clinical judgement had sensitivity 56% (95% CI 47% to 65%) and specificity 89% (95% CI 81% to 94%). Positive likelihood ratio was higher in people aged 70-79 years (6.5, 95% CI 2.9 to 15) compared to people aged ≥ 80 years (3.6, 95% CI 1.7 to 7.6), and in women (10.4, 95% CI 3.4 to 31.7) compared to men (3.2, 95% CI 1.7 to 6.2), whereas the negative likelihood ratio was similar in all groups. Conclusion: GP judgement is more likely to under identify rather than over identify dementia.

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THU0346 SARC-F PERFORMANCE FOR SARCOPENIA SCREENING IN PATIENTS WITH SYSTEMIC SCLEROSIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2241 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 404.1-404

Author(s):

V. Hax ◽

R. Santo ◽

L. Santos ◽

M. Farinon ◽

M. De Oliveira ◽

...

Keyword(s):

Systemic Sclerosis ◽

Likelihood Ratio ◽

Handgrip Strength ◽

Pulmonary Function Tests ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Youden Index ◽

Routine Practice ◽

Test Accuracy ◽

European Working

Background:Because the method of diagnosing sarcopenia is complex and is considered to be difficult to introduce into routine practice, the European Working Group on Sarcopenia in Older People’s (EWGSOP) recommends use of the SARC-F questionnaire as a way to introduce assessment and treatment of sarcopenia into clinical practice1. Only recently, some studies have focused their attention on the presence of sarcopenia in systemic sclerosis (SSc) and there is no data about the performance of SARC-F in this population.Objectives:To test the diagnostic properties of the SARC-F questionnaire for sarcopenia screening in SSc patients.Methods:Cross-sectional study, including 94 SSc patients assessed by clinical evaluation, laboratory and pulmonary function tests. Sarcopenia was evaluated using the EWGSOP diagnostic criteria updated in 2019 (EWGSOP2): dual-energy X-ray absorptiometry, handgrip strength, and short physical performance battery (SPPB)1. Participants also completed the SARC-F questionnaire. The questionnaires’ performances were evaluated through receiver operating characteristic (ROC) curves and standard measures of diagnostic accuracy were computed using the EWGSOP2 criteria as the gold standard for diagnosis of sarcopenia.Results:Sarcopenia was identified in 15 (15,9%) SSc patients by the EWGSOP2 criteria. Area under the ROC curve of SARC-F screening for sarcopenia was 0.588 (95% confidence interval (CI) 0.482, 0.688) (figure 1). The results of sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR) with the EWGSOP2 criteria as the reference standard were 35.71 [95% CI, 12.76-64.86], 81.01 (95% CI, 70.62-88.97), 1.88 (95% CI, 0.81-4.35) and 0.79 (95% CI, 0.53-1.19), respectively. The optimal cut-off point of SARC-F in our sample was ≥ 4 (Youden index: 0.21), the same cut-off point recommended in the literature2,3. Only 6 (40%) out of the 15 participants with sarcopenia were identified by the SARC-F questionnaire in our population. However, the SARC-F properly identified 4 out of 5 patients who had severe sarcopenia.Conclusion:This is the first study to evaluate the performance of SARC-F questionnaire for sarcopenia screening in patients with SSc. Although it appropriately identifies severe cases of sarcopenia, the SARC-F alone may not be an adequate screening tool in high-risk populations, such as SSc, that may benefit from early intervention and treatment.References:[1]Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31.[2]Malmstrom TK, Morley JE. SARC-F: A simple questionnaire to rapidly diagnose sarcopenia. J Am Med Dir Assoc. 2013;14(8):531-532.[3]Ida S, Kaneko R, Murata K. SARC-F for Screening of Sarcopenia Among Older Adults: A Meta-analysis of Screening Test Accuracy. J Am Med Dir Assoc. 2018;19(8):685-689.Disclosure of Interests:Vanessa Hax: None declared, Rafaela Santo: None declared, Leonardo Santos: None declared, Mirian Farinon: None declared, Marianne de Oliveira: None declared, Guilherme Levi Três: None declared, Andrese Aline Gasparin: None declared, M Bredemeier: None declared, Ricardo Xavier Consultant of: AbbVie, Pfizer, Novartis, Janssen, Eli Lilly, Roche, Rafael Mendonça da Silva Chakr: None declared

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SURE Test Accuracy for Decisional Conflict Screening among Parents Making Decisions for Their Child

Medical Decision Making ◽

10.1177/0272989x19884541 ◽

2019 ◽

Vol 39 (8) ◽

pp. 1010-1018 ◽

Cited By ~ 1

Author(s):

Laura Boland ◽

France Légaré ◽

Daniel I. McIsaac ◽

Ian D. Graham ◽

Monica Taljaard ◽

...

Keyword(s):

Primary Care ◽

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Internal Consistency ◽

Secondary Analysis ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Decisional Conflict ◽

Test Accuracy ◽

Specific Calculation

Background. We aimed to validate the SURE test for use with parents in primary care. Methods. A secondary analysis of cluster randomized trial data was used to compare the SURE test (index, higher score = less conflict) to the Decisional Conflict Scale (DCS; reference, higher score = greater conflict). Our a priori hypothesis was that the scales would correlate negatively. We evaluated the association between scores and estimated the proportion of variance in the DCS explained by the SURE test. Then, we dichotomized each measure using established cutoffs to calculate diagnostic accuracy and internal consistency with confidence intervals adjusted for clustering. We evaluated the presence of effect modification by sex, followed by sex-specific calculation of validation statistics. Results. In total, 185 of 201 parents completed a DCS and SURE test. Total DCS (mean = 4.2/100, SD = 14.3) and SURE test (median 4/4; interquartile range, 4–4) scores were significantly correlated (ρ = −0.36, P < 0.0001). The SURE test explained 34% of the DCS score variance. Internal consistency (Kuder-Richardson 20) was 0.38 ( P < 0.0001). SURE test sensitivity and specificity for identifying decisional conflict were 32% (95% confidence interval [CI], 20%–44%) and 96% (95% CI, 93%–100%), respectively. The SURE test’s positive likelihood ratio was 8.4 (95% CI, 0.1–17) and its negative likelihood ratio was 0.7 (95% CI, 0.53–0.87). There were no significant differences between females and males in DCS ( P = 0.5) or SURE test ( P = 0.97) total scores; however, correlations between test total scores (–0.37 for females v. for –0.21 for males; P = 0.001 for the interaction) and sensitivity and specificity were higher for females than males. Conclusions. SURE test demonstrated acceptable psychometric properties for screening decisional conflict among parents making a health decision about their child in primary care. However, clinicians cannot be confident that a negative SURE test rules out the presence of decisional conflict.

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A novel RET gene mutation in a neonate with total colonic aganglionosis and renal agenesis: a case report

Pediatric Review International Journal of Pediatric Research ◽

10.17511/ijpr.2020.i08.08 ◽

2020 ◽

Vol 7 (8) ◽

pp. 437-441

Author(s):

Dr. Ravi Teja Goud M ◽

◽

Dr. K. Lalatendu Kumar ◽

Dr. S. Nasreen Banu ◽

◽

...

Keyword(s):

Likelihood Ratio ◽

Prospective Observational Study ◽

Severe Acute Malnutrition ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Acute Malnutrition ◽

Youden Index ◽

Care Hospital ◽

Total Colonic Aganglionosis ◽

Sensitivity Specificity

Objective: To find the MUAC cut-off for detection of severe acute malnutrition in infants between 1to 6 months of age. Material and Methods: A prospective observational study at IPD and OPD of atertiary care hospital. 303 infants between one and six months of age above the length of 45cmswere included in the study. In infants between one and six months of age, the length, weight, andMUAC were measured. SAM infants were identified using the WHO definition. Sensitivity, specificity,and Youden index for a particular MUAC was calculated in SAM infants. Results: 11cms was found tohave a sensitivity of 85.1% and specificity of 65.9%. It had the maximum Youden index of 0.55 witha positive likelihood ratio of 2.79 and a negative likelihood ratio of 0.21. Conclusions: MUAC of11cms can be used as a cut-off for SAM infants between 1 to 6 months of age. MUAC does not varywith gender. Weight and MUAC are significantly lower in SAM infants. But there is no difference whenit comes to length as in acute malnutrition, the weight and MUAC are affected but length is not.

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Diagnostic Laboratory Tests for COVID-19 in US: Methodology and Performance

10.21203/rs.3.rs-43374/v1 ◽

2020 ◽

Author(s):

Mrigendra M. Bastola ◽

Craig Locatis ◽

Paul Fontelo

Keyword(s):

Likelihood Ratio ◽

Sensitivity And Specificity ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Small Sample ◽

Published Data ◽

Test Accuracy ◽

Rt Pcr ◽

Likelihood Ratios ◽

Predictive Values

Abstract Background: COVID-19 is a global pandemic caused by a new coronavirus strain. Innovative tests have been developed to diagnose and characterize the spread of COVID-19. Only a few studies have reported the diagnostic value of currently available tests. The diagnostic performance of the tests is a major concern after the recent resurgence in COVID-19. Methods: Published papers and FDA data on the currently available tests were used for analysis. Likelihood ratios, and predictive values of tests were computed. Only FDA approved tests were included. RT-PCR performance among different specimen types were also explored.Main results: All the published reports on the COVID-19 tests reported RT-PCR as the validation tool for their results. Not all available COVID-19 tests reported their sensitivity and specificity. Among the publications which reported, the positive likelihood ratio ranged between 0.15 to 0.88 and tests had high negative likelihood ratio (0.99). Conclusion: Although most recent publications showed high positive and negative likelihood ratios and high predictive values, the publications on test accuracy and validity have limited scope primarily due to their small sample size and insufficiencies in methodology and published data. Although most lab tests reported high sensitivity and specificity, false omission and false discovery rates were found notable in several COVID-19 lab tests. These results suggest need for caution on test results’ interpretation. Practitioners also need to integrate evidence that is evolving rapidly.

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Is the diagnostic value of either ESR or CRP sufficient to exclude the need to measure both in paediatric patients presenting with non-traumatic limb pain?

Emergency Medicine Journal ◽

10.1136/emj.2010.103150.21 ◽

2010 ◽

Vol 27 (Suppl 1) ◽

pp. A8.1-A8

Author(s):

Sara Robinson

Keyword(s):

Emergency Department ◽

Likelihood Ratio ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Roc Curves ◽

Final Diagnosis ◽

Diagnostic Value ◽

Likelihood Ratios ◽

Limb Pain ◽

Time Of Presentation

BackgroundLaboratory tests for cases of suspected orthopaedic infection usually include measurement of both the erythrocyte sedimentation rate (ESR) and the C reactive protein (CRP). This has a time and cost implication for the laboratories. The measurement of both also requires a larger volume blood sample, which can be difficult to obtain.ObjectiveTo assess if the measurement of either CRP or ESR individually has a likelihood ratio equivalent to that of the measurement of both.SettingEmergency Department of a Paediatric Teaching Hospital.Study designRetrospective study of Case Notes for patients attending the Emergency Department with a complaint of atraumatic limb pain and in whom both ESR and CRP were measured at the time of presentation. Laboratory results at the time of presentation were recorded along with the final diagnosis. Receiver operating characteristic (ROC) curves were created using the data. Likelihood Ratios for ESR and CRP individually and in combination were calculated.Results259 patients were included in the study of whom 17 were considered to have an Orthopaedic infection. The ROC curves revealed the best results were obtained using cut off values of CRP>7 and ESR>12. The combination of a CRP>7 and an ESR>12 gave the best positive Likelihood Ratio at 6.26 (Likelihood ratio 5.34 (CRP>7) vs 2.57 (ESR>12)) For ruling out disease the combination of CRP≤7 and an ESR≤12 also outperformed either variable individually (negative likelihood ratio 0.09 (CRP≤7 and ESR≤12) vs 0.34 (CRP≤7) vs 0.18 (ESR≤12)).ConclusionA raised CRP is a more specific indicator of orthopaedic infection than a raised ESR; however the ESR is more sensitive. Thus the Likelihood Ratios produced by the combination of the two results are superior to those of either measurement individually. The measurement of both CRP and ESR should be considered an important aid in the investigation of atraumatic limb pain.

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Thrombocytopenia as a prognostic marker in COVID-19 patients: diagnostic test accuracy meta-analysis

Epidemiology and Infection ◽

10.1017/s0950268821000236 ◽

2021 ◽

Vol 149 ◽

Author(s):

Raymond Pranata ◽

Michael Anthonius Lim ◽

Emir Yonas ◽

Ian Huang ◽

Sally Aman Nasution ◽

...

Keyword(s):

Likelihood Ratio ◽

Subgroup Analysis ◽

Meta Analysis ◽

Invasive Mechanical Ventilation ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Intensive Care Unit Care ◽

Test Accuracy ◽

Poor Outcome

Abstract This systematic review and meta-analysis aimed to evaluate thrombocytopenia as a prognostic biomarker in patients with coronavirus disease 2019 (COVID-19). We performed a systematic literature search using PubMed, Embase and EuropePMC. The main outcome was composite poor outcome, a composite of mortality, severity, need for intensive care unit care and invasive mechanical ventilation. There were 8963 patients from 23 studies. Thrombocytopenia occurred in 18% of the patients. Male gender (P = 0.037) significantly reduce the incidence. Thrombocytopenia was associated with composite poor outcome (RR 1.90 (1.43–2.52), P < 0.001; I2: 92.3%). Subgroup analysis showed that thrombocytopenia was associated with mortality (RR 2.34 (1.23–4.45), P < 0.001; I2: 96.8%) and severity (RR 1.61 (1.33–1.96), P < 0.001; I2: 62.4%). Subgroup analysis for cut-off <100 × 109/l showed RR of 1.93 (1.37–2.72), P < 0.001; I2: 83.2%). Thrombocytopenia had a sensitivity of 0.26 (0.18–0.36), specificity of 0.89 (0.84–0.92), positive likelihood ratio of 2.3 (1.6–3.2), negative likelihood ratio of 0.83 (0.75–0.93), diagnostic odds ratio of 3 (2, 4) and area under curve of 0.70 (0.66–0.74) for composite poor outcome. Meta-regression analysis showed that the association between thrombocytopenia and poor outcome did not vary significantly with age, male, lymphocyte, d-dimer, hypertension, diabetes and CKD. Fagan's nomogram showed that the posterior probability of poor outcome was 50% in patients with thrombocytopenia, and 26% in those without thrombocytopenia. The Deek's funnel plot was relatively symmetrical and the quantitative asymmetry test was non-significant (P = 0.14). This study indicates that thrombocytopenia was associated with poor outcome in patients with COVID-19. PROSPERO ID: CRD42020213974

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Clinical judgement of GPs for the diagnosis of dementia: a diagnostic test accuracy study

BJGP Open ◽

10.3399/bjgpo.2021.0058 ◽

2021 ◽

pp. BJGPO.2021.0058

Author(s):

Samuel Thomas Creavin ◽

Judy Haworth ◽

Mark Fish ◽

Sarah Cullum ◽

Anthony Bayer ◽

...

Keyword(s):

Diagnostic Test ◽

Likelihood Ratio ◽

Positive Likelihood Ratio ◽

Diagnostic Test Accuracy ◽

Clinical Judgement ◽

Test Accuracy ◽

Index Test ◽

Duration Of Symptoms ◽

Diagnosis Of Dementia ◽

Accuracy Study

BackgroundGPs often report using clinical judgement to diagnose dementia.AimInvestigate the accuracy of GPs’ clinical judgement for the diagnosis of dementia.Design & settingDiagnostic test accuracy study, recruiting from 21 practices around Bristol.MethodThe clinical judgement of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged over 70 years who had cognitive symptoms. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to ICD-10 criteria for dementia.Results240 people were recruited, with a median age of 80 years (IQR 75–84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12–36 months) and the median ACE-III score was 75 (IQR 65–87). GP clinical judgement had sensitivity 56% (95% CI 47% to 65%) and specificity 89% (95% CI 81% to 94%). Positive likelihood ratio was higher in people aged 70–79 years (6.5, 95% CI 2.9–15) compared to people aged ≥80 years (3.6, 95% CI 1.7–7.6), and in women (10.4, 95% CI 3.4–31.7) compared to men (3.2, 95% CI 1.7–6.2), whereas the negative likelihood ratio was similar in all groups.ConclusionA GP clinical judgement of dementia is specific, but confirmatory testing is needed to exclude dementia in symptomatic people who GPs judge as not having dementia.

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Abstract 1122‐000033: Automated Detection of Intracerebral Hemorrhage Using Artificial Intelligence: Pilot Deployment of Viz ICH

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000033 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Roshini Kalagara ◽

Susmita Chennareddy ◽

Stavros Matsoukas ◽

Emma Reford ◽

Colton Smith ◽

...

Keyword(s):

Artificial Intelligence ◽

Intracerebral Hemorrhage ◽

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Predictive Value ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Index Test ◽

Scan Time ◽

Initial Care

Introduction : Stroke is a major cause of morbidity and mortality. Hemorrhagic strokes are often more severe and associated with higher mortality when compared to ischemic stroke and account for approximately 13% of all strokes. Initial care for patients with intracerebral hemorrhage (ICH) is in part guided by neuroimaging findings. Non‐contrast computed tomography (NCCT) is often the first imaging obtained in the work up of the acute stroke patient given its diagnostic accuracy for hemorrhage, ubiquity, low cost, and short scan time. Immediate evaluation of imaging by stroke experts, such as neurologists, neurosurgeons, and radiologists, is essential. Artificial intelligence tools can help to expedite image assessment and careteam coordination thereby accelerating time to treatment. In this study, we report on the use of Viz ICH, an AI‐enhanced ICH detection platform, to identify ICH on initial CT and coordinate emergent care in an urban health system with an ICH Center. Methods : All consecutive stroke codes presenting with ICH from May 2019 to August 2019 were eligible for analysis. Non‐contrast CT (NCCT) was conducted for each patient and submitted to the Viz ICH in a prospective fashion. An automated volumetric analysis of these NCCTs was conducted by Viz ICH and assessment was conducted for potential ICH. If suspected ICH was detected, Viz ICH sent an automated prompt to the stroke care team for review. CT impressions provided by radiologists served as the clinical reference standard test and Viz ICH output served as the index test. Diagnostic accuracy tests were then performed. Results : A total of 682 patients were analyzed for ICH, out of which 28 patients were positive for intracerebral hemorrhage (ICH) (4%) and 654 were negative for hemorrhage (96%) based on radiology impressions. Viz ICH was able to correctly identify hemorrhages in 25/28 patients and non‐hemorrhages in 650/654 patients. Overall, the software had high diagnostic accuracy with 89.3% sensitivity, 99.4% specificity, and an overall accuracy of 99.0%. The software also had a positive predictive value of 86.2%, a negative predictive value of 99.5%, a positive likelihood ratio of 145.98, and a negative likelihood ratio of 0.108. Conclusions : Viz ICH is an AI‐enhanced platform that may help in the diagnosis and detection of ICH, with a sensitivity of 89.3 and a specificity of 99.4% in this preliminary study. Though future validation studies with a larger cohort of patients positive for each type of hemorrhage must be conducted for true diagnostic accuracy data, Viz ICH has the potential to be an adjunct tool to streamline ICH triage, reduce treatment delays, and improve outcomes of patients presenting with ICH.

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Reliability of the Edinburgh Claudication Questionnaire for Identifying Symptomatic PAD in General Practice

Angiology ◽

10.1177/0003319720984882 ◽

2021 ◽

pp. 000331972098488

Author(s):

Luke Boylan ◽

Craig Nesbitt ◽

Lesley Wilson ◽

John Allen ◽

Andrew Sims ◽

...

Keyword(s):

General Practice ◽

Likelihood Ratio ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Methods ◽

Test Accuracy ◽

Reference Standard ◽

Ultrasound Scanning ◽

Vascular Ultrasound ◽

North East

The Edinburgh Claudication Questionnaire (ECQ) was developed to help identify peripheral arterial disease (PAD) in the general population but has not been validated against diagnostic arterial imaging methods such as Duplex Vascular Ultrasound Scanning (DUS). In the present study, we assessed the accuracy of the ECQ for diagnosis using DUS. As part of a National Institute of Health Research funded project looking at novel diagnostic methods, 250 patients were studied from 15 general practices across North East England from May 2015 and November 2016. Practices identified those with a PAD diagnosis from their registers as well as age- and sex-matched controls. All the ECQs were recorded by a vascular specialist nurse. Duplex vascular ultrasound scanning was used as a reference standard for the diagnosis of occlusive PAD. The ECQ had a sensitivity of 52.5% (95% CI: 42.3%-62.5%), specificity of 87.1% (95% CI: 80.6%-92.0%), positive likelihood ratio of 4.06 (95% CI: 2.57-6.42), and negative likelihood ratio of 0.55 (95% CI: 0.44-0.68) compared with reference standard DUS. The ECQ has relatively poor overall diagnostic test accuracy in isolation. It may be helpful in ruling out PAD or as a supplementary test to improve diagnosis of symptomatic disease in General Practice.

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