Document Detail

Are toe pressures measured by a portable photophlethysmograph equivalent to standard laboratory tests?
MedLine Citation:
PMID:  20736862     Owner:  NLM     Status:  MEDLINE    
PURPOSE: The purpose of this study was to determine if toe pressures (TPs) obtained by a registered nurse using a portable photophlethysmograph (PPG) were equivalent to TPs obtained by a registered vascular technologist (RVT) using standard laboratory equipment.
DESIGN: A within-subjects, comparative design was used for the study.
SETTING AND SUBJECTS: Thirty subjects referred to a vascular laboratory for arterial studies were recruited. All tests were performed in the outpatient vascular laboratory of a large, urban medical center.
METHODOLOGY: Toe pressures were measured on subjects by the same RN and RVT during the same visit. Data were analyzed using the Bland-Altman method that compares bias (mean difference) and precision (limits of agreement) of measurements to previously determined criterion for clinically important limits of difference (±15 mm Hg) in order to assess equivalence and repeatability of measurements. Kappa statistic was calculated to assess RVT/RN agreement to detect lower extremity arterial disease (LEAD) (ie, TP<50 mm Hg). Sensitivity and specificity of the portable PPG measures were determined.
RESULTS: Precision for RVT-RN TPs exceeded the previously determined cutoff criteria (±15 mm Hg), but precision for repeated RN PPG measures fell within the clinically important limits. Kappa statistic calculation (κ=0.76) revealed substantial agreement (90%) between the RVT and RN measures to detect LEAD (<50 mm Hg). The portable PPG technique had good sensitivity (79%) and high specificity (95%) for detection of LEAD.
CONCLUSION: Although TPs obtained by the portable PPG were not equivalent to standard laboratory tests, the portable technique agreed sufficiently with the RVT to detect LEAD. The good sensitivity and high specificity of the portable PPG make it suitable for nurses and other primary care providers to use for high-risk patients or patients with wounds, when the ankle brachial index either is elevated above 1.3 or cannot be performed. Photophlethysmograph is also suitable to assess healing potential and the need for referrals to the vascular laboratory, surgeon, or the need for adjunctive therapies.
Phyllis A Bonham; Teresa Kelechi; Martina Mueller; Jacob Robison
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society / WOCN     Volume:  37     ISSN:  1528-3976     ISO Abbreviation:  J Wound Ostomy Continence Nurs     Publication Date:    2010 Sep-Oct
Date Detail:
Created Date:  2010-09-14     Completed Date:  2011-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9435679     Medline TA:  J Wound Ostomy Continence Nurs     Country:  United States    
Other Details:
Languages:  eng     Pagination:  475-86     Citation Subset:  N    
Wound Care Education Program, College of Nursing, Medical University of South Carolina, and Department of Vascular Surgery, Medical University Hospital, Charleston, SC 29425, USA.
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MeSH Terms
Aged, 80 and over
Ambulatory Care / methods
Ankle / blood supply
Ankle Brachial Index
Arterial Occlusive Diseases / diagnosis,  nursing
Brachial Artery*
Clinical Laboratory Techniques / standards
Cohort Studies
Hospitals, University
Middle Aged
Nurse Clinicians*
Peripheral Arterial Disease / diagnosis*,  nursing
Photoplethysmography / instrumentation,  methods
Reproducibility of Results
Toes / blood supply*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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