Purpose. Peripheral arterial disease (PAD) is a major risk factor for adverse cardiovascular events. There has been a definite push for wider use of the ankle-brachial index (ABI) as a simple screening tool for PAD. This has occurred perhaps to the detriment of a good physical examination? The purpose of our study was to assess the accuracy of the physical examination to detect clinically significant PAD when compared to the 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 a normal ABI between 0.91 - 1.30 and those with an abnormal 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 (1) or absent (0). 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 or exclusion of PAD when compared to the ABI. If both peripheral foot pulses are present in both lower limbs and there are no femoral bruits, the specificity and negative predictive values of 98.6% and 95.0% respectively makes the measurement of the ABI seem redundant. The emphasis in PAD detection should be directed towards a good physical examination.