A REASSESSMENT OF DOPPLER PRESSURE INDEXES IN THE DETECTION OF ARTERIAL LESIONS IN PROXIMITY PENETRATING INJURIES OF EXTREMITIES - A PROSPECTIVE-STUDY

This prospective study assessed the role of Doppler pressure indices ( Ankle-Brachial Index [ABI] or Brachial Brachial Index [BBI]) in the ev aluation for occult arterial injury from penetrating proximity extremi ty trauma (PET), A total of 298 patients with 323 PETs were evaluated by physical examination and Doppler pressure (ABI/BBI) determination, An ABI/BBI of <0.9 was considered abnormal, The findings were compared with those of arteriography in all patients, Eleven injuries (3.4%) f ound on arteriography were associated with normal indices, Five of the se injuries were treated by repair (4 patients) or angiographic emboli zation of a bleeding vessel (1 patient), all in lesions proximal to th e knee or elbow joints. The other six lesions were observed without in tervention, All of the 29 injuries associated with abnormal indices ha d positive arteriographic findings, The 4 lesions that were treated op eratively were proximal and the remaining 25, all with distal penetrat ion, were observed without intervention, As compared to angiography, D oppler indices yielded the following results: 283 true-negative, 11 fa lse-negative, 29 true positive, and 0 false-positive, for a sensitivit y of 72.5%, a specificity of 100%, a positive predictive value of 100% , and a negative predictive value of 96%, These data suggest that Dopp ler indices should be an integral part of the physical examination and can screen patients with proximal injuries for further studies such a s duplex sonography or arteriography. (Copyright (C) 1996 by W.B. Saun ders Company)