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Distal pulse palpation: is it reliable?
M Lundin1, J P Wiksten, T Peräkylä
1Department of Surgery, Division of Vascular Surgery, Helsinki University Central Hospital, P.O. Box 262, 00029 HUCH, Helsinki, Finland.
Insights
Pulse palpation for lower limb arterial disease is unreliable, leading to significant misdiagnosis. Objective measurements are crucial, though careful palpation can be tolerable in ideal conditions.
Area of Science:
- Vascular Medicine
- Diagnostic Accuracy
Background:
- Distal pulse palpation is a common method for assessing lower limb arterial disease.
- The reliability of this technique, especially in busy clinical settings, requires further investigation.
Purpose of the Study:
- To evaluate the diagnostic reliability of distal pulse palpation in patients with suspected lower limb arterial disease.
- To compare the agreement among different healthcare professionals and settings.
Main Methods:
- Palpation of dorsalis pedis and tibialis posterior arteries in 25 patients.
- Independent assessment by vascular surgeons, medical students, vascular nurses, and a physician.
- Comparison of palpation findings with ankle/brachial index (ABI) measurements.
Main Results:
- A high degree of misdiagnosis (over 30% underdiagnosis) was observed.
- Agreement was highest in a quiet vascular laboratory (kappa 0.68) and lowest in a busy outpatient clinic (kappa 0.38).
- Ankle/brachial index (ABI) cutoff of 0.76 best separated palpable from unpalpable pulses.
Conclusions:
- Pulse palpation alone is insufficient for diagnosing lower limb arterial disease due to poor agreement and high misdiagnosis rates in busy clinics.
- Objective measurements like ABI are necessary when ischemia is suspected.
- Careful palpation under non-hurried conditions can yield tolerable accuracy.
Abstract:
The aim of this study was to evaluate the reliability of distal pulse palpation. The dorsalis pedis and the tibialis posterior arteries of 25 patients with suspected lower limb arterial disease were independently palpated by three vascular surgeons and three medical students in the outpatient clinic and by two vascular nurses and one physician in the vascular laboratory. The palpation findings were compared to the ankle/brachial index (ABI). Palpable and unpalpable pulses were best separated with ABI 0.76 as the cutoff point. The degree of misdiagnosis was unacceptably high, with an underdiagnosis of more than 30%. The agreement was highest (kappa 0. 68, good) among the vascular laboratory personnel in the peaceful vascular laboratory and lowest (kappa 0.38, fair) among the vascular surgeons in the busy outpatient clinic. The poor agreement and the high proportion of misdiagnosis obtained in the outpatient clinic argue against the use of pulse palpation as a single diagnostic method. Palpable pulses with low ABIs clearly state the need for more objective measurements whenever ischemia is suspected. Yet, by carefully palpating both pedal arteries under good, nonhurried conditions the reproducibility and accuracy of pulse palpation can be tolerable.