Brearley S, Shearman C P, Simms M H
Department of Surgery, Selly Oak Hospital, Birmingham.
Ann R Coll Surg Engl. 1992 May;74(3):169-71.
Fifty observers, including two fully trained vascular surgeons, were asked to determine the presence or absence of the femoral and distal pulses of four patients with peripheral vascular disease and one asymptomatic subject (50 pulses assessed). Pulses felt by both vascular surgeons were deemed to be palpable. Among the other observers, the sensitivity of palpation was 95% or over for the femoral pulse, but 33% to 60% for observers of varying experience feeling for the posterior tibial pulse. Up to 20% false-positive observations were reported. Disease was diagnosed in over 10% of examinations of healthy limbs and was missed in over 10% of symptomatic limbs. The accuracy of pulse palpation was strongly correlated with the systolic blood pressure in the underlying artery. Accuracy was greater among more experienced observers, suggesting that careful teaching of this skill is likely to be beneficial. Even so, pulse palpation alone is an unreliable physical sign and should only be used in combination with objective measurements as a guide to clinical management.
五十名观察者，包括两名训练有素的血管外科医生，被要求判断四名外周血管疾病患者和一名无症状受试者的股动脉和远端脉搏是否存在（共评估50次脉搏）。两名血管外科医生都能摸到的脉搏被视为可触及。在其他观察者中，股动脉触诊的敏感性为95%或更高，但对于不同经验的观察者而言，胫后动脉触诊的敏感性为33%至60%。报告的假阳性观察结果高达20%。在超过10%的健康肢体检查中诊断出疾病，在超过10%的有症状肢体中漏诊。脉搏触诊的准确性与潜在动脉的收缩压密切相关。经验更丰富的观察者准确性更高，这表明对该技能进行仔细教学可能会有益。即便如此，仅靠脉搏触诊是不可靠的体征，仅应与客观测量相结合用于指导临床管理。
