Palpation versus hand‑held Doppler for identifying lower‑limb peripheral arteries: Time‑efficiency and reliability in healthy adults

Abstract

Background

Bedside lower‑limb vascular assessment commonly relies on pedal pulse palpation or hand‑held Doppler, yet their relative time‑efficiency and the reliability of Doppler measurements in novices are unclear.

Methods

Twenty healthy adults were examined by three undergraduate raters without prior Doppler experience. For dorsalis pedis, anterior tibial, and posterior tibial arteries, each rater performed three trials with palpation and with a hand‑held continuous‑wave Doppler. Primary outcomes were time‑to‑identification and identification success; for Doppler, peak systolic velocity (PSV) reliability was evaluated (intra‑ and inter‑rater intraclass correlation coefficients [ICC] and Bland–Altman).

Results

Differences were defined as Doppler—palpation (positive values indicate longer time for Doppler). Palpation was faster than Doppler for dorsalis pedis (Hodges–Lehmann +6.47 s, 95% confidence interval [CI]: 2.40–8.00; p = 0.004) and posterior tibial arteries (+6.38 s, 1.10–13.61; p = 0.012). The anterior tibial artery was never identified by palpation but was identified by Doppler in all participants (exact McNemar p = 1.91 × 10⁻⁶). Doppler reliability for dorsalis pedis PSV was excellent within raters (ICC [3.1]: 0.926–0.971) and between raters (ICC [2.1]: 0.966), with small mean biases and narrow limits of agreement.

Conclusions

In healthy adults, palpation enables faster identification of dorsalis pedis and posterior tibial pulses, whereas the deeper anterior tibial artery is consistently detected only with Doppler. Doppler‑derived PSV shows excellent reproducibility even among novice examiners. These findings provide methods-level evidence to inform protocol design and training; validation in patient populations is required before any workflow recommendations.