Reliability of NonInvasive Vascular Lab Interpretation in a Rural Hospital Setting

1
Reliability of Non-Invasive Vascular Lab
Interpretation in a Rural Hospital Setting

• Thomas Whitehill, MD, FACS
• William Rainer, MD, LRCSI, FACS
• Allan R. Mottram MSIII

2
Peripheral Arterial Disease

• Obstruction of blood supply to extremities.
• Manifests as
• Intermittent Claudication / Rest Pain.
• 8-10 million individuals in U.S.
• Evaluation in a variety of settings.

3
Purpose

• To assess the reliability of interpretation of
  non-invasive vascular labs in a rural setting.

4
Non-Invasive TestingLower Extremity Arterial
Study

• Segmental Limb Pressures (SLP)
• Pulse Volume Recording (PVR)
• Exercise Testing
• Doppler Waveform Analysis

5
Methods

• 18 non-invasive LE arterial vascular labs
• Randomly selected consecutive series
• Independent interpretations in 2 settings
• Rural vs. Tertiary
• Evaluation of consistency between interpreters

6
Locations

• Rural
• William Rainer, MD, FACS
• Southwest Memorial Hospital, Cortez CO
• Tertiary
• Thomas Whitehill, MD, FACS
• UCHSC, Denver CO

7
Scoring

• SLP, PVR, Doppler and Final Diagnosis
• disease presence or absence
• laterality agreement or disagreement
• level agreement or disagreement
• Treadmill
• disease presence or absence
• Severity of Final Diagnosis
• 1 none
• 2 mild
• 3 moderate
• 4 severe

8
No Significant Difference Between Settings in
Interpretation of Presence of Disease
Treadmill
Doppler
SLP
PVR
9
No Significant Difference Between Settings in
Interpretation of Laterality of Disease
SLP
Doppler
PVR
10
No Significant Difference Between Settings in
Interpretation of Level of Disease
Doppler
SLP
PVR
11
Correlation Between Settings in Interpretation of
Presence of Disease
12
Correlation Between Interpretations of Severity
of Disease
N 1
N 1
N 1
N 9
N 6
13
Conclusions

• No statistically significant differences in
  interpretations
• Strong correlation between interpretations
• Greater variability for PVR compared with
  SLP/Doppler
• In this series
• non-invasive vascular lab interpretations in a
  rural setting are reliable

14
Thank You

• COLORADO CHAPTER, AMERICAN COLLEGE OF SURGEONS
• Cardiopulmonary Dept., Southwest Memorial
  Hospital
• Lou and Darren
• Thomas Whitehill, MD, FACS
• Dr. William Rainer, MD, FACS
• Allan Mottram, MSIII
• Carol J MacGillis, PT