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Organisation d’un dépistage de l'anévrisme de l’aorte abdominale et de l’artériopathie oblitérante des membres inférieurs en secteur de soins primaires : mise en place de l’étude pilote DAG au sein des maisons médicales
Mémoire de Master / Thèse d'exercice   Open Access

Organisation d’un dépistage de l'anévrisme de l’aorte abdominale et de l’artériopathie oblitérante des membres inférieurs en secteur de soins primaires : mise en place de l’étude pilote DAG au sein des maisons médicales

Sophie Gilli
Masters , Université de Montpellier
15/06/2018

Résumé

Screening Aneurysm Primary Care Concordance Ultrasound Dépistage Anévrisme Soins primaires Concordance Échographie
BACKGROUND: aneurysm of the abdominal aorta and arterial disease of the lower limbs kill as much as breast cancer or prostate cancer. It remains under diagnosed in France. 80% die from a broken aneurysm that is has gone by undetected. Screening in a target population is a public health issue for the HAS. OBJECTIVE: to evaluate the interobserver consistency of ultrasound measurements of the abdominal aorta by a general practitioner and an expert in the primary care sector. METHODS: feasibility study in a prospective multicentric, cohort, for validation of a method of ultrasound measurement of the anteroposterior diameter in longitudinal and transverse sections of the abdominal aorta by portable ultrasound. The inclusion period was from October 2014 to December 2017 in the Gard department. After a 3-hour training, the novice practitioners measured the abdominal aortic diameter of 300 patients according to the SFMV criteria and performed an IPS (o) to detect an AOMI. The proofreading was performed by the expert physician, blind to previous results. RESULTS: coefficient of correlation of concordance is between 0.54 and 0.61 depending on the section. The mean variability of aortic diameter measurements between novice and expert is 2.5 mm. 85% to 91% of ultrasonographic measurements show interobserver variability of less than 5 mm. The prevalence of AAA is 3% CI 95% [1.5%; 5.8%] and that of AOMI is 33.2%. 92% of the images evaluated by the expert are judged as interpretable. CONCLUSION: the use of Doppler ultrasound and IPSO in general practice can provide an effective and durable solution to AAA and AOMI screenings.

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