CX Executive Board member Una Adderley (Wakefield, UK), director of the National Wound Care Strategy Programme for the National Health Service (NHS) England, spoke recently at the 2019 Charing Cross Symposium (CX; 15–18 April, London, UK) on the challenge of ankle-brachial pressure index (ABPI) for managing vascular disease. Adderley argued for the benefits of introducing ABPI assessment, claiming the data supports that a significant majority of amputations due to chronic vascular disease could be prevented with its use.
Adderley told CX delegates attending the iWounds session that an “accurate diagnosis is the foundation of any treatment decision”. The ankle-brachial pressure index is, she argued, a “relatively accurate” test for arterial insufficiency—“more valid and reliable than pedal pulse palpation and more portable than Duplex scanning”. Furthermore, Adderley pointed to the bed of literature that raises issues of interpretation with other diagnostic methods, such as peripheral pulse palpation.
In addition to allegedly inaccurate diagnostic tools, Adderley directed the audience’s attention to an All-Party Parliamentary Group report on vascular and venous disease in the UK highlighted that “every two hours, a patient in England loses their leg due to complications” related to peripheral arterial disease. Adderley explained she saw this as an opportunity for improvement, telling the CX audience yesterday: “With early arterial assessment, 80% of these amputations would be prevented”.
Adderley then commented on what she perceived as the “sub-optimal use of compression for venous leg ulceration”. Citing support from articles published in Journal of Wound Care and Journal of Tissue Viability, she informed attendees that in north-east England, 23.6% of leg and foot ulcers are not assessed using Doppler ultrasound, and 46% of venous leg ulcers in the same region are not in compression. Data from an individual English health care district evidenced that 33.6% of leg ulcers are not assessed using Doppler ultrasound, and 25% of venous leg ulcers are not in compression.
Using this data as evidence of a problem with the management of vascular disease in England, Adderley said that the solution was the early use of the ankle-brachial pressure index measurement. She called for a service redesign, emphasising, in her eyes, what the benefits would be: “Opportunities for deliberate practice, access to equipment, and knowledge reinterpretation”.
