An absent pulse is not sensitive for the early detection of peripheral arterial disease

This study's objective was to determine the test characteristics of pedal pulse palpation in the diagnosis of peripheral arterial disease (PAD) when compared to the more widely recommended screening tool, the ankle-brachial index (ABI).

We screened patients > 50 years of age for PAD within primary care clinics in Houston. PAD was diagnosed by an ABI of <0.9. At each visit, pedal pulse palpation was performed for each leg. Of the patients who screened positive for PAD by ABI, we determined the sensitivity, specificity, and positive predictive value of pulse palpation.

We enrolled 403 patients with a mean age of 63.8 +/- .36 years. The prevalence of PAD was 16.6% (67 patients total). Of the 45 patients with disease involving their left leg, 37 (82.2%) had a palpable pulse. Of the 37 patients with disease involving their right leg, 25 (67.6%) had a palpable pulse. The sensitivity of a non-detectable pulse for the diagnosis of PAD was 17.8% and 32.4% for the left leg and the right leg, respectively. The specificity of pulse palpation for the detection of PAD was 98.7% and 97.8% for the left leg and the right leg, respectively.

Pulse palpation is not sensitive for the detection of PAD compared to ABI. More than two thirds of the patients within our cohort with PAD of either the left or right leg had a detectable pulse.