TITLE:
Pulse palpation and limited joint mobility examination are better indicators than oscillometric measurement for diagnosing abnormal ankle-brachial index
AUTHORS:
Laura Rantamaula, Juha Varis, Ilkka Kantola
KEYWORDS:
Peripheral Artery Disease; Blood Pressure; Ankle-Brachial Index; Oscillometric ABI Measurement
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.4 No.2,
February
26,
2014
ABSTRACT: Background: Peripheral artery disease (PAD) is the least
recognized form of atherosclerosis and may even result in amputation if the
diagnosis is delayed. Manual pulse palpation is the traditional way to diagnose
PAD. Doppler ultrasonographic measurement of ankle-brachial index (ABI) is the
gold standard diagnosing method but requires training and is not necessarily
available as an outpatient procedure. Using automated oscillometric blood
pressure devices has been suggested as an easier method for measuring the ABI. Methods:
A single observer palpated the arterial dorsalis pedis, examined hand joints
and measured the ABI of one hundred diabetic patients using both Doppler and
oscillometric methods. The purpose of this study was to compare the oscillometric
method and the manual diagnosing methods to the gold standard method of using a
hand held Doppler device for measuring the ABI and detecting PAD. Results: ABI
was abnormal in 24 patients (24%) (22 males, 2 females) when measured with the
Doppler method. Of these 24 patients, the oscillometric method would have
missed 12 giving 12 false negatives. We found that the sensitivity of the
oscillometric method was 50.0% and specificity 90.8%. Clinical examination with
palpation of ADP combined with limited joint mobility (LJM) scoring would have
missed only four cases. Conclusions: Although the oscillometric method is
easy and accessible, it is not sensitive enough to be used as the only method
in measuring ABI. The simple and inexpensive ADP pulse palpation combined with
testing for LMJ was able to find 20 of the 24 (83%) patients with an abnormal
ABI measured by Doppler stethoscope.