Dorsal Pedal Pulse Palpation Predictions
Dorsal Pedal Pulse Palpation Predictions
Correlation between dorsal pedal pulse palpation and hand-held Doppler measurement of ankle pressure in patients referred to a specialized leg and foot ulcer clinic at a dermatological department was investigated. Complete data regarding palpable dorsal pulse and ankle-brachial index (ABI) was available for 510 patients. Palpable dorsal pedal pulse was present in 337 patients and absent in 173. Mean ABI in patients with palpable pulses was 1.07 (median 1.07, range 0.35-1.79). Mean ABI in patients without palpable pulses was 0.79 (median 0.80, range 0.22-1.31). The difference was significant (p < 0.0001). In the group without palpable pedal pulses, 39.8 percent had an ABI > 0.9. In the group with palpable pedal pulses, 52 patients (15.4%) had an ABI ≤ 0.9. While there is a strong association between ABI and palpable pedal pulse, the latter delivers 40-percent false negative predictions in alerting professionals to the presence of arterial disease as defined by ABI ≤ 0.9. Measurement of the arterial circulation using a hand-held Doppler is thus considered mandatory at first visit in all patients seeking advice for leg and foot ulcers.
Leg ulceration is a common disease that inflicts substantial suffering on the patient and causes great economic strain on the healthcare system. Several recent studies in Sweden have found a point prevalence in the healthcare system varying between 0.12 and 0.3 percent. Leg ulceration is not a disease per se but a symptom of an underlying disease in large or small blood vessels, physical agents, such as trauma, hydrostatic or mechanical pressure, and neoplasms. In previous years, establishment of etiological diagnosis has been of poor quality. Thus, estimation of the arterial circulation has mainly rested on palpation of pedal pulses, especially in the dorsal pedal artery. Identification of the pedal pulse, however, may be difficult in many patients, especially in those with edema. In recent years, a simple diagnostic tool, the hand-held Doppler, has become available outside vascular surgery departments making etiological diagnosis on the arterial side simple and mandatory. The present report deals with the correlation between dorsal pedal pulse palpation and hand-held Doppler measurement of ankle pressure in a patient population examined at a specialized leg ulcer clinic by certified specialists in dermatology.
Abstract
Correlation between dorsal pedal pulse palpation and hand-held Doppler measurement of ankle pressure in patients referred to a specialized leg and foot ulcer clinic at a dermatological department was investigated. Complete data regarding palpable dorsal pulse and ankle-brachial index (ABI) was available for 510 patients. Palpable dorsal pedal pulse was present in 337 patients and absent in 173. Mean ABI in patients with palpable pulses was 1.07 (median 1.07, range 0.35-1.79). Mean ABI in patients without palpable pulses was 0.79 (median 0.80, range 0.22-1.31). The difference was significant (p < 0.0001). In the group without palpable pedal pulses, 39.8 percent had an ABI > 0.9. In the group with palpable pedal pulses, 52 patients (15.4%) had an ABI ≤ 0.9. While there is a strong association between ABI and palpable pedal pulse, the latter delivers 40-percent false negative predictions in alerting professionals to the presence of arterial disease as defined by ABI ≤ 0.9. Measurement of the arterial circulation using a hand-held Doppler is thus considered mandatory at first visit in all patients seeking advice for leg and foot ulcers.
Introduction
Leg ulceration is a common disease that inflicts substantial suffering on the patient and causes great economic strain on the healthcare system. Several recent studies in Sweden have found a point prevalence in the healthcare system varying between 0.12 and 0.3 percent. Leg ulceration is not a disease per se but a symptom of an underlying disease in large or small blood vessels, physical agents, such as trauma, hydrostatic or mechanical pressure, and neoplasms. In previous years, establishment of etiological diagnosis has been of poor quality. Thus, estimation of the arterial circulation has mainly rested on palpation of pedal pulses, especially in the dorsal pedal artery. Identification of the pedal pulse, however, may be difficult in many patients, especially in those with edema. In recent years, a simple diagnostic tool, the hand-held Doppler, has become available outside vascular surgery departments making etiological diagnosis on the arterial side simple and mandatory. The present report deals with the correlation between dorsal pedal pulse palpation and hand-held Doppler measurement of ankle pressure in a patient population examined at a specialized leg ulcer clinic by certified specialists in dermatology.
