Does the clinical examination predict lower extremity peripheral arterial disease?

Area of Science:

• Vascular Medicine
• Diagnostic Accuracy
• Clinical Examination

Background:

• Peripheral arterial disease (PAD) is a prevalent condition linked to increased morbidity and mortality.
• Physicians rely on clinical examination to identify patients requiring further diagnostic testing for PAD.

Purpose of the Study:

• To systematically review the accuracy and precision of the clinical examination in diagnosing PAD.
• Evaluate the diagnostic utility of various physical examination findings and patient history elements.

Main Methods:

• A comprehensive literature search of MEDLINE and Cochrane databases was conducted for studies on PAD diagnosis via physical examination.
• Included studies compared clinical findings against reference standards like ankle-brachial index, duplex sonography, or angiography.
• Data extraction and quality review were performed independently by two authors.

Main Results:

• For asymptomatic patients, claudication, femoral bruit, and pulse abnormalities are key indicators of PAD.
• In symptomatic patients, cool skin, bruits, and pulse abnormalities are significant diagnostic findings.
• Absence of bruits or pulse abnormalities can decrease the likelihood of PAD.
• A PAD scoring system incorporating a handheld Doppler demonstrated superior diagnostic accuracy.

Conclusions:

• Clinical examination findings for PAD should be interpreted alongside pretest probability.
• Individual clinical findings are insufficient to definitively diagnose or exclude PAD.
• A PAD screening score utilizing a handheld Doppler provides the highest diagnostic accuracy.