Distal Pulse Palpation: Is It Reliable?

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.

Validation and comparison of currently available stratification systems for patients with diabetes by risk of foot ulcer development

“…This corroborates our systematic review results: DPN and PVD clinical collection methods seem relatively unimportant (4,15). Although several authors have described the foot pulse palpation to have low sensitivity (16,17), the SWM application procedure does not have consensus (18,19) and the tuning fork has low reliability (19); several studies have shown that these simple methods can be implemented for both community (2,8,15,19,20) and high risk (3, 4) setting diabetic foot screening, independently of the variables collection method.…”

Evaluation of a Hip Fracture Risk Score for Assessing Elderly Women: The Melton Osteoporotic Fracture (MOF) Study

“…Circulation was assessed by palpating the dorsalis pedis; it was defined as good if a pulse was present and poor if a pulse was weak or absent. The reliability of this measure has previously been demonstrated to be 'good' (kappa) [22] under unhurried conditions, using trained professionals. Cognitive impairment was measured using the Clifton Assessment Procedure for the Elderly (CAPE) [23].…”

The role of pulse oximetry in chiropractic practice: a rationale for its use

“…[29][30][31][32] A more reliable method to assess cardiovascular health is warranted. It has been recommended that patients at risk for hypoxic conditions be monitored using pulse oximetry.…”