Exploring The Diagnostic Accuracy of Ineffective Peripheral Tissue Perfusion For Nursing Care in Diabetic Foot Patients

Summary

This study evaluates the diagnostic accuracy of the nursing diagnosis "Ineffective Peripheral Tissue Perfusion" in diabetic foot patients against TcPO₂ as the gold standard and identifies key defining characteristics for a more precise diagnostic model.

Abstract

“Ineffective Peripheral Tissue Perfusion" is a recognized NANDA-I nursing diagnosis, but its diagnostic accuracy for diabetic foot patients lacks evidence-based support. This study aimed to evaluate the diagnostic accuracy of this nursing diagnosis in hospitalized diabetic foot patients. A retrospective study of 89 diabetic foot patients was conducted from January 2023 to December 2024. Trained nurses independently applied the NANDA-I diagnosis. Transcutaneous oxygen pressure (TcPO₂) < 30 mmHg served as the gold standard. Receiver operating characteristic (ROC) curves were plotted to calculate the area under the curve (AUC), sensitivity, and specificity for the overall diagnosis and for each of its 12 defining characteristics. The top three characteristics were combined into a new diagnostic model.

Compared to the TcPO₂ gold standard, the nursing diagnosis showed a sensitivity of 83.33% and a specificity of 86.96%, with an AUC of 0.851. Among the diagnostic performances of the 12 defining characteristics, "Color does not return to lowered limb after 1 min leg elevation" had the best performance (AUC=0.881), followed by "Edema" (AUC=0.835), and "Absence of peripheral pulses" had moderate performance (AUC=0.712). The combined diagnosis had a sensitivity of 84.85%, a specificity of 91.30%, PLR and NLR values of 9.76 and 0.17, respectively, and an increased AUC of 0.904, indicating superior overall diagnostic performance of the combined diagnosis. The AUC of the combined diagnosis was 0.053 higher than that of the nursing diagnosis, with a statistically significant difference (p=0.048).

The nursing diagnosis "Ineffective Peripheral Tissue Perfusion" is a valid tool for assessing diabetic foot patients. However, a focused assessment for "Color does not return to lowered limb after 1 min leg elevation," "Edema," and "Absence of peripheral pulses" provide even greater diagnostic accuracy.

Introduction

In the global spectrum of chronic diseases, diabetes has emerged as a significant public health threat to human health, with its prevalence increasing annually¹. According to the latest epidemiological survey released by the International Diabetes Federation (IDF), the global prevalence of diabetes among individuals aged 20-79 was 10.5% in 2021, with the number of affected individuals reaching 537 million. It is projected that this proportion will rise to 12.2% by 2045, with the number of patients reaching 783 million². Diabetic foot is one of the complications that severely endanger the life and health of diabetic patie....

Protocol

The study was conducted in accordance with the Declaration of Helsinki¹⁷ and the protocol was approved by the Zhejiang Medical and Health Group Hangzhou Hospital Ethics Committee (Approval No.: 202604281616000065088). Written informed consent was obtained from all participants prior to inclusion in the study. All patient data were anonymized and handled confidentially to ensure privacy and data protection.

1. Preparation of study materials and personnel training

1. Development of assessment forms
   1. Create a standardized assessment form listing all 12 defining characteristics for &#....

Results

Table 1 presents the baseline characteristics of the 89 hospitalized patients with diabetic foot included in this study. In terms of gender distribution, there were 46 males (51.69%) and 43 females (48.31%), indicating a relatively balanced gender composition. The mean age of the patients was 68.55 ± 5.12 years, and the mean body mass index (BMI) was 24.64 ± 1.56 kg·(m²)^-1. The median disease duration was 9 (8, 11) years, suggesting that the majority of patients had long-standing di.......

Discussion

Diabetic foot, as one of the most devastating chronic complications of diabetes, poses a severe challenge to global healthcare systems due to its high rates of amputation, recurrence, and mortality²². Insufficient peripheral tissue perfusion, a core pathophysiological mechanism underlying the development and progression of diabetic foot, results from the combined effects of vascular endothelial dysfunction, microcirculatory remodeling, and atherosclerosis induced by chronic hyperglycemia

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
75g Oral Glucose Tolerance Test (OGTT) Kit	Various (hospital supply)	Standardized medical-grade OGTT solution	Administered according to WHO diagnostic criteria for diabetes confirmation.
Ankle-Brachial Index (ABI) Measurement System	Hokanson, USA	MD6 / Doppler probe	Optional perfusion assessment tool referenced in discussion; not used as primary outcome.
Blood Glucose Monitoring System	Roche Diagnostics, Switzerland	Accu-Chek® Performa	Used for fasting and random plasma glucose measurements, calibrated regularly per manufacturer guidelines.
Capillary Refill Time Assessment Tool (Digital Timer)	Omron, Japan	HS-36T	Used for standardized measurement of capillary refill time (>3 seconds).
Edema Assessment Scale (Pitting Edema Grading)	Self-developed / Clinical standard	N/A	Used to classify edema severity (1+ to 4+) during physical examination.
HbA1c Analyzer	Bio-Rad Laboratories, USA	D-100™ System	NGSP-certified method with CV < 3% for diabetes diagnosis and monitoring.
Inter-Rater Reliability Checklist	Self-developed	N/A	Used during training to evaluate consistency among nurses in assessing defining characteristics.
Laser Doppler Perfusion Imager	Perimed AB, Sweden	PIM 3	Referenced in discussion for microvascular assessment; not used in current study.
Limb Elevation Support Pillow	Medical-grade foam	Standard hospital issue	Used for standardized 1-minute leg elevation test.
Peripheral Pulse Palpation Simulator (Training)	Kyoto Kagaku Co., Japan	M55A	Used during nurse training for pulse assessment consistency.
Statistical Analysis Software	IBM, USA	SPSS Statistics 25.0	Used for ROC curve analysis, AUC calculation, sensitivity, specificity, and other diagnostic performance metrics.
Transcutaneous Oxygen Pressure (TcPO2) Monitor	Radiometer, Denmark	TCM4	Used to measure tissue oxygen tension with heated electrode set at 43–44°C, following established protocols for peripheral perfusion assessment in diabetic foot.