Predictive value of the Edinburgh claudication questionnaire in diagnosing peripheral arterial disease among Nigerian adults

Abstract

Abstract Background: Although Peripheral arterial disease (PAD) is a strong predictor of adverse cardiovascular events, it is frequently unrecognized and under diagnosed. When the diagnosis is considered, it is often made by eliciting the presence of intermittent claudication using the Edinburgh Claudication Questionnaire (ECQ) whereas the Ankle Brachial Index (ABI) is a simpler and more objective means of making the diagnosis with a sensitivity and specificity of > 90%. Objective : To determine the predictive values of Edinburgh Claudication Questionnaire in the diagnosis of PAD among adult patients in Sagamu, south western Nigeria. Methods: A cross-sectional study of 400 patients aged > 50 years attending the General Out- Patients Clinic of Olabisi Onabanj o University Teaching Hospital, Sagamu, Nigeria was carried out. ECQ was administered on all the subjects to determine the presence of intermittent claudication (IC) and their ABI were also measured. A value of ABI d 0.9 was taken as diagnostic of PAD. The prevalence of PAD, the sensitivity, specificity, positive and negative predictive value s of E C Q against ABI were evaluated. . . . Results: Using ECQ 25 (6.3%) of the patients had PAD while 99 (24.8%) had PAD when ABI was used. Among these 99 patients, 17(17.2%) had symptoms consistent with IC based on ECQ. The presence of 1C was significantly associated with ABI values d"0.9 (p - 0.000).The sensitivity of ECQ was 17.2% while the specificity was 99% with a positive predictive value of 85% and a negative predictive value of 77.7%. Conclusion: The ECQ is not a useful tool for the screening of PAD given its low sensitivity. Its use would result in missing a large number of patients with asymptomatic PAD who would have benefitted from interventions.