The Kingston Heart Clinic, Ontario, Canada.
Can J Cardiol. 2010 Dec;26(10):e346-50. doi: 10.1016/s0828-282x(10)70467-0.
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. Perhaps this has occurred to the detriment of a thorough physical examination.
To assess the accuracy of the physical examination to detect clinically significant PAD compared with the ABI.
PADfile, the PAD module of CARDIOfile (the Kingston Heart Clinic's cardiology database [Kingston, Ontario]), was searched for all patients who underwent peripheral arterial testing. Of 1619 patients, 1236 had all of the necessary data entered. Patients' lower limbs were divided into two groups: those with a normal ABI between 0.91 and 1.30, and those with an abnormal ABI of 0.90 or lower. 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 and overall accuracy were calculated for the dorsalis pedis pulse, the posterior tibial pulse, both pedal pulses, 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.
In 1236 patients who underwent PAD testing and who underwent a complete peripheral vascular physical examination (all dorsalis pedis and posterior tibial pulses palpated and auscultation for a femoral bruit), the sensitivity, specificity, NPV, positive predictive value and accuracy for PAD were 58.2%, 98.3%, 94.9%, 81.1% and 93.8%, respectively.
The clinical examination of the peripheral arterial foot pulses and the auscultation for a femoral bruit had a high degree of accuracy (93.8%) for the detection or exclusion of PAD compared with the ABI using the cut-off of 0.90 or lower. If both peripheral foot pulses are present in both lower limbs and there are no femoral bruits, the specificity and NPV of 98.3% and 94.9%, respectively, make the measurement of the ABI seem redundant. The emphasis in PAD detection should be redirected toward encouraging a thorough physical examination.
外周动脉疾病（PAD）是不良心血管事件的主要危险因素。已经明确推动更广泛地使用踝臂指数（ABI）作为 PAD 的简单筛查工具。也许这是以彻底的体格检查为代价的。
评估体格检查检测临床显著 PAD 的准确性与 ABI 相比。
PADfile，即 CARDIOfile 的 PAD 模块（Kingston 心脏诊所的心脏病数据库[安大略省金斯敦]），搜索了所有接受外周动脉检查的患者。在 1619 名患者中，有 1236 名患者输入了所有必要的数据。将患者的下肢分为两组：ABI 在 0.91 到 1.30 之间正常的组，以及 ABI 为 0.90 或更低的异常组。外周脉搏分为缺失或存在。缺失评为 0⁄3，存在但减少（1⁄3），正常（2⁄3）或博动（3⁄3）。股动脉杂音评为存在（1）或缺失（0）。以 ABI 为金标准，计算背动脉脉搏、胫后动脉脉搏、两个足背脉搏、股动脉杂音的存在或缺失以及最后一个足背脉搏和股动脉杂音的存在或缺失的灵敏度、特异性、阴性预测值（NPV）、阳性预测值和总体准确性。
在 1236 名接受 PAD 检查并接受完整的外周血管体格检查（所有背动脉和胫后动脉脉搏触诊和股动脉杂音听诊）的患者中，PAD 的灵敏度、特异性、NPV、阳性预测值和准确性分别为 58.2%、98.3%、94.9%、81.1%和 93.8%。
与使用 0.90 或更低的截断值的 ABI 相比，外周动脉足部脉搏的临床检查和股动脉杂音的听诊对 PAD 的检测或排除具有很高的准确性（93.8%）。如果双侧下肢的所有足背脉搏都存在，且无股动脉杂音，则特异性和 NPV 分别为 98.3%和 94.9%，这使得 ABI 的测量显得多余。PAD 检测的重点应重新转向鼓励进行彻底的体格检查。
