Peripheral pulse palpation: an unreliable physical sign

Fifty observers, including two fully trained vascular surgeons, were asked to determine the presence or absence of the femoral and distal pulses of four patients with peripheral vascular disease and one asymptomatic subject (50 pulses assessed). Pulses felt by both vascular surgeons were deemed to be palpable. Among the other observers, the sensitivity of palpation was 95% or over for the femoral pulse, but 33% to 60% for observers of varying experience feeling for the posterior tibial pulse. Up to 20% false-positive observations were reported. Disease was diagnosed in over 10% of examinations of healthy limbs and was missed in over 10% of symptomatic limbs. The accuracy of pulse palpation was strongly correlated with the systolic blood pressure in the underlying artery. Accuracy was greater among more experienced observers, suggesting that careful teaching of this skill is likely to be beneficial. Even so, pulse palpation alone is an unreliable physical sign and should only be used in combination with objective measurements as a guide to clinical management.