Distal pulse palpation: Is it reliable?

The aim of this study was to evaluate the reliability of distal pulse palpa tion. The dorsalis pedis and the tibialis posterior arteries of 25 patients with suspected lower limb arterial disease mere 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, T he palpation findings were compared to the ankle/brachial index (ABI). Palp able and unpalpable pulses were best separated with ABI 0.76 as the cutoff point. The degree of misdiagnosis was unacceptably high, with an underdiagn osis of more than 30%. The agreement was highest (kappa 0.68, good) among t he vascular laboratory personnel in the peaceful vascular laboratory and lo west (kappa 0.38, fair) among the vascular surgeons in the busy outpatient clinic. The Door agreement and the high proportion of misdiagnosis obtained in the outpatient clinic argue against the use of pulse palpation as a sin gle diagnostic method. Palpable pulses with low ABIs clearly state the need for more objective measurements whenever ischemia is suspected. Yet, by ca refully palpating both pedal arteries under good, nonhurried conditions the reproducibility and accuracy of pulse palpation can be tolerable.