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THE ACCURACY OF THE PHYSICAL EXAMINATION FOR THE DETECTION OF PERIPHERAL ARTERIAL DISEASE

THE ACCURACY OF THE PHYSICAL EXAMINATION FOR THE DETECTION OF PERIPHERAL ARTERIAL DISEASE Author Block: A Thakrar, D Armstrong, D Brouillard, C Tobin, M MatangiKingston, Ontario Abstract:PURPOSE: To assess the accuracy of the physical examination to detect clinically significant peripheral arterial disease (PAD) when compared to the ankle-brachial index (ABI).METHODS: PADfile, the peripheral arterial disease module of CARDIOfile, our cardiology database was searched for all patients who had peripheral arterial testing. Patients’ lower limbs were divided into two groups, those with an ABI >0.90 and those with an ABI of <0.91. Peripheral pulses were graded as either absent or present. Absent was graded as (0/3), present but reduced (1/3), normal (2/3) or bounding (3/3). Femoral bruits were graded as either present or absent. Using the ABI as the gold standard, the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and overall accuracy were calculated for the, dorsalis pedis pulse (DP), the posterior tibial pulse (PT), both pedal pulses, for the presence or absence of a femoral bruit and finally for a combination of both pedal pulses and the presence or absence of a femoral bruit.RESULTS: See Table 1.CONCLUSIONS: The clinical examination of the peripheral arterial foot pulses and the auscultation for a femoral bruit has a high degree of accuracy (94.1%) for the detection of PAD when compared to the ABI. In fact if both peripheral foot pulses are present in both lower limbs and there are no femoral bruits, the specificty and negative predictive values of 98.6% and 95.0% respectively makes the measurement of the ABI seem redundant. Table 1. PAD exam Number Sensitivity (%) Specificity (%) PPV (%) NPV (%) Accuracy (%) DP pulse only 2033 61.5 81.8 40.8 91.3 83.4 PT pulse only 2133 66.4 83.2 45.1 92.3 80.3 Both pulses 1685 68.6 91.6 61.4 93.8 87.9 Femoral bruit 2033 33.9 93.3 49.6 87.9 83.8 Both pulses and femoral bruit. 1275 54.3 98.6 81.4 95.0 94.1 :Author Disclosure Information:  A. Thakrar, None; D. Armstrong, None; D. Brouillard, None; C. Tobin, None; M. Matangi, None.