Table 6, Clinical evidence summary: diagnostic test accuracy for pulse palpation (12 lead ECG interpreted by expert cardiologist/electrophysiologist as gold standard) - Accuracy of tests for detection

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Table 6Clinical evidence summary: diagnostic test accuracy for pulse palpation (12 lead ECG interpreted by expert cardiologist/electrophysiologist as gold standard)

Where 95% CIs are provided in round brackets (or no 95% CIs are given), raw data were not available and Forest Plots or pooled analyses were not possible.

Index Test	Number of studies	n	Interpreter of index test	Gold standard simultaneous with index	Sensitivity (95% CI)	Specificity (95% CI)	Risk of bias	Indirectness	Inconsistency	Imprecsion	GRADE
Pulse palpation 1 reading(unknown duration)	2 Hobbs, 2005¹⁰⁴ Somerville, 2000²⁴⁰ Somerville, 2000²⁴⁰	2616	Clinician Clinician expert	yes no no	0.87 [0.82, 0.91] 0.92 [0.64, 1.00] 1.00 [0.87, 1.00] Pooled:0.92(0.71-0.99)^d	0.81 [0.80, 0.83] 0.84 [0.64, 0.95] 0.77 [0.64, 0.87] Pooled:0.81(0.56-0.94)^d	Sensitivity
							serious^a	serious^b	No serious inconsistency	Serious^c	VERY LOW
							Specificity
							serious^a	serious^b	No serious inconsistency	very serious^d	VERY LOW

(a): Risk of bias was assessed using the QUADAS-2 checklist. The evidence was downgraded by 1 increment if the majority of studies were rated at high risk of bias, and downgraded by 2 increments if the majority of studies were rated at very high risk of bias.
(b): Indirectness was assessed using the QUADAS-2 checklist items referring to applicability. The evidence was downgraded by 1 increment if the majority of studies were seriously indirect, and downgraded by 2 increments if the majority of studies are very seriously indirect
(c): Imprecision was assessed based on inspection of the confidence region in the diagnostic meta-analysis or, where diagnostic meta-analysis has not been conducted, assessed according to the range of confidence intervals in the individual studies. The evidence was downgraded by 1 increment when the confidence interval around the point estimate crossed one of the clinical thresholds (0.90 or 0.60), and downgraded by 2 increments when the confidence interval around the point estimate crossed both of the clinical thresholds. The upper clinical threshold marked the point above which recommendations would be possible, and the lower clinical threshold marked the point below which the tool would be regarded as of little clinical use.
(d): Pooled sensitivity/specificity from diagnostic meta-analysis

From: Accuracy of tests for detection

Cover of Accuracy of tests for detection

Accuracy of tests for detection: Atrial fibrillation: diagnosis and management: Evidence review B.

NICE Guideline, No. 196.

National Guideline Centre (UK).

London: National Institute for Health and Care Excellence (NICE); 2021 Apr.

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