Reliability of ankle-brachial pressure index measured by pulse palpation method in diagnosing peripheral arterial disease among patients with diabetes mellitus

Abstract

Introduction: Ankle brachial pressure index (ABI) is a useful screening test to detect peripheral arterial disease (PAD). However, the limitation for the widespread use of this test is the lack of doppler devices in most of the resource poor settings. In contrast, the pulse palpation method requires only a blood pressure apparatus with a suitable cuff and is a cheaper and readily available alternative. Materials and methods: The objective of this study is to evaluate the accuracy and reproducibility of ABI measured by pulse palpation method and to study the correlation between the pulse palpation and doppler method. Population of 193 patients with diabetes were examined by two trained medical officers and ABI was measured by each examiner using pulse palpation method (pABI) and doppler method (dABI). Results: There was a statistically significant difference between the values obtained by the two observers for both dABI and pABI. There was a significant difference between dABI and pABI measurements (p<0.01). The pABI was lower than the dABI, but there was a significant positive correlation between dABI and pABI in both lower limbs (p<0.01). Conclusion: According to our study, pABI had a sensitivity of 62% and a specificity of 90% in diagnosing PAD. Even though the doppler method cannot be replaced by pulse palpation method, there was a significant positive correlation between the two methods indicating that the pABI can be utilized to predict the pABI in resource poor setting.

Keywords

• ankle brachial pressure index, doppler device, peripheral arterial disease, resource poor setting, palpation method