This well-conducted review reliably concluded that pulse palpation can be useful for ruling out atrial fibrillation.

To determine the accuracy of pulse palpation to detect atrial fibrillation (AF).

MEDLINE and EMBASE were searched from inception to June 2005; details of the search strategy were reported. The reference lists of all possibly relevant studies, including review articles, were screened.

No inclusion criteria relating to the study design were specified. Two studies were diagnostic cohort studies and one was a diagnostic case-control study.

Studies in which all patients received pulse palpation were eligible for inclusion. In all studies a nurse carried out the pulse palpation.

Studies in which all patients received an electrocardiogram (ECG) as the reference standard were eligible for inclusion. In all studies a cardiologist carried out the ECG diagnosis.

No inclusion criteria relating to the participants were specified. All studies included patients aged over 65 years from UK general practices.

The studies had to report sufficient data to calculate the sensitivity and specificity, or this had to be provided by the study authors.

Two reviewers independently screened the results of the searches. Full text documents of relevant papers were obtained, and the two reviewers assessed these for inclusion according to predetermined criteria. Included articles were agreed by both authors.

Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool (see Other Publications of Related Interest). Two reviewers independently assessed quality.

Two reviewers independently extracted the data.

Pooled sensitivity and specificity values were calculated using Metatest (New England Medical Center, Boston). Pooled positive and negative likelihood ratios (LRs) were calculated with the random-effects model of DerSimonian and Laird, using Cochrane RevMan software.

The studies were assessed for heterogeneity using the chi-squared and I-squared tests in the Cochrane RevMan software.

Three studies (n=2,385) were included in the review.

The sensitivity ranged from 91 to 100% and the specificity from 70 to 77%. The pooled sensitivity was 94% (95% confidence interval, CI: 84, 97) and the pooled specificity 72% (95% CI: 69, 75). Positive LRs ranged from 3.1 to 4.1 and negative LRs from 0.024 to 0.12. The pooled positive LR was 3.4 (95% CI: 3.2, 3.7) and the pooled negative LR 0.11 (95% CI: 0.06, 0.20). The chi-squared test for heterogeneity was 3.87 (P=0.14) for the positive LR and 1.49 (P=0.49) for the negative LR, indicating the consistency of results between studies.

Pulse palpation can be used to rule out AF as it has a high sensitivity, although specificity is relatively low. It may also be used to screen opportunistically for previously undetected AF.

This was a well-conducted and very clearly reported review. The review question was supported by clearly defined inclusion criteria. A reasonable literature search was conducted, although further attempts to identify unpublished studies could have been undertaken. Details of the review process, including appropriate steps to minimise bias, were reported. A flow diagram showed the flow of studies through the review. The methods used to pool studies were appropriate. The authors' conclusions are supported by the results presented.

Practice: The authors stated that it may be worth considering opportunistic testing for AF, particularly in patients with ischaemic heart disease or heart failure. Even among these patients, cases of paroxysmal AF may be missed, whether using pulse palpation or ECG. You may, therefore, want to repeat the test periodically.

Research: The authors did not state any implications for research.

Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 2003;3:25.

This record is a structured abstract written by CRD reviewers. The original has met a set of quality criteria. Since September 1996 abstracts have been sent to authors for comment. Additional factual information is incorporated into the record. Noted as [A:....].