The LEGS Scorecolon; A Proposed Grading System to Direct Treatment of Chronic Lower Extremity Ischemia

摘要

ObjectiveTo prospectively compare the Lower Extremity Grading System (LEGS)-derived ldquo;recommended treatmentrdquo; to the actual treatment performed and to analyze LEGS intergrader scoring consistency by comparing blinded scoring results between physician graders.Summary Background DataDue to technical advances and the increased medical complexity of the aging population, the most appropriate treatment for chronic lower extremity ischemiamdash;open surgery versus endovascularmdash;is again in flux. In an attempt to standardize management, the LEGS score, based on the best available outcomes data, was devised by the physicians of an established vascular service.MethodsFrom March to June 2002, all chronically ischemic lower extremities that met standard indications for revascularization were prospectively enrolled and independently graded with the LEGS score by an ldquo;endovascular surgeonrdquo; and an ldquo;open surgeonrdquo; for comparative analysis. The results were then blindly evaluated to determine whether the LEGS-derived ldquo;recommended treatmentrdquo; agreed with the actual treatment rendered and to assess for intergrader consistency. Agreement was assessed using kappa statistical analysis.ResultsOf the 137 presenting limbs (mean patient age 66.4 yo; 43percnt; claudication, 57percnt; limb-threatening ischemia), 107 were treated (65percnt; endovascular, 30percnt; open surgery, 5percnt; amputation), 16 were pending treatment, and 14 were not treated because of patient refusal (n equals; 13) or death (n equals; 1). The LEGS score predicted the actual or offered clinical treatment in 90percnt; of cases. The LEGS score comparison between physician graders resulted in identical ldquo;recommended treatmentrdquo; in 116 of 128 cases for a 90.6percnt; agreement.ConclusionsA reproducible scoring system to guide the treatment of patients with chronic lower extremity ischemia is possible. While systems like the LEGS score may have potential clinical application, their use as a treatment standardization tool for future prospective outcomes comparisons between open and endovascular surgery will be essential.