Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
Copyright 2002 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.2002
In Reply: We agree with Dr Gaylis that a good
history and physical examination is a cost-effective means to diagnose PAD.
Nevertheless, while the clinical examination can provide important signs of
PAD, the peripheral pulse examination has been shown to be insensitive to
accurately diagnosis PAD. In one study,1
the sensitivity of any abnormal pulse was 77%, the specificity was 86%, the
positive predictive value (PPV) was 40%, and the negative predictive value
was 97%. Another study,2 in contrast, found
the sensitivity of an absent pulse for PAD was only 5%. Thus, in this study
the PPV was as low as 20%. From these data we infer that the presence of a
normal pedal pulse could potentially identify approximately 90% of patients
who do not have PAD, but an absent pulse cannot serve as a reliable indicator
of PAD. This imperfect sensitivity and PPV of the pulse examination are the
critical reasons for our advocacy of greater use of the ABI. The judicious
use of the simple, inexpensive handheld Doppler device, like the use of a
stethoscope, can improve the accuracy of real-world PAD diagnosis.
Hirsch AT, Hiatt WR, Criqui MH. Diagnosis and Treatment of Peripheral Arterial Disease—Reply. JAMA. 2002;287(3):313-316. doi:10.1001/jama.287.3.313