REPRODUCIBILITY AND ACCURACY AMONG PRIMARY-CARE PROVIDERS OF A SCREENING EXAMINATION FOR FOOT ULCER RISK AMONG DIABETIC-PATIENTS

Background A clinical examination has been shown to stratify patients by risk for diabetic foot ulcer; it is unknown whether primary care pr oviders can reproducibly perform this examination. Methods. One hundre d forty-seven consecutive diabetic patients at six Veterans Affairs Me dical Centers received a structured history and physical examination o f the feet from each of two primary care providers; 88 of these patien ts were also examined by a foot care specialist. The examination consi sted of a previously validated four-component diabetic foot ulcer risk stratification examination and a vascular disease history and physica l examination. Results. Seventy-nine percent of patients were assessed as having elevated risk for development of foot ulcer. Interobserver agreement for risk stratification was moderate (kappa = 0.51; 95% CI 0 .40, 0.62). The agreement for individual components of the stratificat ion examination was variable, with K statistics ranging from 0.36 to 0 .91. Primary care providers had good sensitivity and specificity for m ost components of the examination (compared with foot care specialist' s examination as the criterion standard), but frequently were unable t o identify pedal pulses [sensitivity 0.52 (95% CI 0.41, 0.61)] or foot deformity [sensitivity 0.51 (95% CI 0.46, 0.56)]. Conclusions. A vali dated risk stratification foot examination for diabetic patients is re producible and largely accurate when performed by primary care provide rs.