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Spectrum effect and spectrum bias in the oscillometric ankle brachial index to diagnose peripheral arterial disease: Clinical implications

dc.contributor.authorHerráiz-Adillo Á.
dc.contributor.authorCavero-Redondo I.
dc.contributor.authorÁlvarez-Bueno C.
dc.contributor.authorBidner J.
dc.contributor.authorMartínez-Vizcaíno V.
dc.contributor.authorNotario-Pacheco B.
dc.date.accessioned2020-09-02T22:20:28Z
dc.date.available2020-09-02T22:20:28Z
dc.date.issued2018
dc.identifier10.1016/j.atherosclerosis.2018.03.003
dc.identifier.citation272, , 8-13
dc.identifier.issn00219150
dc.identifier.urihttps://hdl.handle.net/20.500.12728/4886
dc.descriptionBackground and aims: The diagnostic performance of the oscillometric ankle brachial index (ABI) to detect peripheral arterial disease (PAD) varies among populations, suggesting a spectrum effect. When this heterogeneity modifies post-test probabilities, a spectrum bias arises. This study evaluates the presence and influence of spectrum effect and spectrum bias on test performance and clinical decisions. Methods: Oscillometric and Doppler ABI were compared in two settings: Primary-Care (333 legs) and Vascular-Service (41 legs). Spectrum effect was assessed using stratification and logistic regression, while spectrum bias was assessed through graphical and statistical tests based on predictive values and likelihood ratios, respectively. Results: Across subgroups, sensitivity ranged from 61.5% to 90.9%, and specificity from 81.8% to 99.1%. Logistic regression confirmed a spectrum effect in setting, diabetes, smoking status and age (univariate), and setting and diabetes (multivariate model). The positive likelihood ratio ranged from 5.0 to 89.1 in subgroups, leading to a spectrum bias in diabetic, smoking (both subgroups) and age (both subgroups). Therefore, a positive test ruled in differently the disease across subgroups, with a high rate of false positives in diabetic, smoking and >75-year-old patients. The negative likelihood ratio ranged from 0.09 to 0.39 in subgroups, with significant spectrum bias in Primary-Care patients, non-diabetics and smokers. Thus, in these subgroups, a negative test ruled out the disease with less certainty. Conclusions: Spectrum effect and spectrum bias were found in oscillometric ABI to detect PAD, potentially affecting clinical decisions, especially for positive tests. Information about spectrum variables and the application of specific subgroups indicators are necessary. © 2018 Elsevier B.V.
dc.language.isoen
dc.publisherElsevier Ireland Ltd
dc.subjectAnkle-brachial index
dc.subjectOscillometry
dc.subjectPeripheral artery disease
dc.subjectSpectrum bias
dc.subjectSpectrum effect
dc.subjectage
dc.subjectaged
dc.subjectankle brachial index
dc.subjectArticle
dc.subjectcardiovascular risk
dc.subjectclinical decision making
dc.subjectclinical evaluation
dc.subjectcross-sectional study
dc.subjectdiabetes mellitus
dc.subjectdiagnostic accuracy
dc.subjectdiagnostic test accuracy study
dc.subjectDoppler flowmetry
dc.subjectdyslipidemia
dc.subjectfalse positive result
dc.subjectfemale
dc.subjectgender
dc.subjecthuman
dc.subjecthypertension
dc.subjectlogistic regression analysis
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectmulticenter study
dc.subjectmultivariate analysis
dc.subjectobesity
dc.subjectoscillometry
dc.subjectperipheral occlusive artery disease
dc.subjectphysical parameters
dc.subjectpredictive value
dc.subjectprimary medical care
dc.subjectpriority journal
dc.subjectprospective study
dc.subjectsensitivity and specificity
dc.subjectsmoking
dc.subjectspectrum bias
dc.subjectspectrum effect
dc.subjectstatistical bias
dc.subjectunivariate analysis
dc.subjectalgorithm
dc.subjectbrachial artery
dc.subjectdiagnostic imaging
dc.subjectDoppler ultrasonography
dc.subjectmiddle aged
dc.subjectoscillometry
dc.subjectperipheral occlusive artery disease
dc.subjectregression analysis
dc.subjectsignal processing
dc.subjectstatistical bias
dc.subjectstatistics
dc.subjectvery elderly
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectAlgorithms
dc.subjectAnkle Brachial Index
dc.subjectBias
dc.subjectBrachial Artery
dc.subjectCross-Sectional Studies
dc.subjectFemale
dc.subjectHumans
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectMultivariate Analysis
dc.subjectOscillometry
dc.subjectPeripheral Arterial Disease
dc.subjectPredictive Value of Tests
dc.subjectRegression Analysis
dc.subjectSensitivity and Specificity
dc.subjectSignal Processing, Computer-Assisted
dc.subjectSmoking
dc.subjectStatistics as Topic
dc.subjectUltrasonography, Doppler
dc.titleSpectrum effect and spectrum bias in the oscillometric ankle brachial index to diagnose peripheral arterial disease: Clinical implications
dc.typeArticle


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