Rate of rise of the carotid pulse. An investigation of observer error in a common clinical measurement.
Bedside estimation of the rate of rise of the carotid pulse is a standard clinical observation whose reliability has not been determined. To ascertain interobserver agreement (primary objective) and compare the velocity of rise of the carotid displacement (not pressure) pulse (supplementary objective), three blinded observers evaluated, ranked and palpated the velocity of rise of carotid pulse as "unremarkable," "slow" or "rapid" in 20 consecutive patients. The relative rate of rise of the recorded carotid pulse was represented by the angle between baseline and the initial carotid peak at a standard paper speed of 100 mm/s. Chi-square analyses yielded no significant interobserver agreements (probability [p] 0.22 to 0.51). There was also no correlation of observers' ranking of rise of carotid pulse with the ranking from independent measurement of the recorded pulse rise velocity (p = 0.10 to 0.99). Observer agreement was unanimous only four times and even in these instances was consistent with the recorded carotid pulse rise velocity only once. The results suggest that unbiased observers cannot reliably discriminate slow from "normal" velocity of rise of carotid pulse.
D000328:Adult; D000368:Aged; D002339:Carotid Arteries; D002648:Child; D002983:Clinical Competence; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010173:Palpation; D011674:Pulse