Diagnostic values of the femoral pulse palpation test

Khammari Nystrom, Fatine
Petersson, Gunnar
Stephansson, Olof
Johansson, Stefan
Altman, Maria

¹ Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
² Division of Obstetrics and Gynecology, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
³ Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institutet, Stockholm, Sweden

Dr Maria Altman, Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; [email protected]

Received February 17, 2019

Received in revised form August 15, 2019

Accepted September 24, 2019

Archives of Disease in Childhood, Fetal & Neonatal Edition 105(4):p 375-379, July 2020. | DOI: 10.1136/archdischild-2019-317066

Objectives

To calculate diagnostic values of the femoral pulse palpation to detect coarctation of the aorta or other left-sided obstructive heart anomalies in newborn infants.

Design

Population-based cohort study.

Setting

Stockholm-Gotland County 2008–2012.

Patients

All singleton live-born infants without chromosomal trisomies, at ≥35 gestational weeks, followed-up until 1–2 years of age.

Main outcome measures

Diagnostic values and ORs for the femoral pulse test and subsequent diagnosis of coarctation of the aorta or left-sided obstructive heart malformation.

Results

Among the 118 592 included infants, 432 had weak or absent femoral pulses at the newborn examination. Seventy-eight infants were diagnosed with coarcation of the aorta and 48 with other left-sided obstructive heart malformations. The diagnostic values for the femoral pulse palpation test to detect coarctation of the aorta were: sensitivity: 19.2%, specificity: 99.6, positive predictive value: 3.5% and negative predictive value: 99.9%. For left-sided heart malformations: sensitivity: 8.3%, specificity: 99.6%, positive predictive value: 0.9% and negative predictive value: 100%. Sensitivity for coarctation of the aorta increased from 16.7% when examined at <12 hours of age to 30.0% at ≥96 hours of age.

Conclusions

The femoral pulse test to detect coarctation of the aorta and left-sided heart malformations has limited sensitivity, whereas specificity is high. As many infants with life-threatening cardiac malformations leave the maternity ward undiagnosed, further efforts are necessary to improve the diagnostic yield of the routine newborn examination.