Reliability of Allen's test in selection of patients for radial artery harvest

Background. Alien's test is widely used to assess the ulnar collateral blood supply of the hand before radial artery harvest for coronary bypass surgery. This study was performed to determine the optimum cut-off point for a positive Alien's test and the clinical reliability of Alien's test in this role. Methods. Patients undergoing coronary artery bypass surgery were examined by independent observers using both Alien's test and a Doppler ultrasound test of the ulnar collateral circulation. Results. We examined 93 hands in 47 patients; mean age was 63.6 years. Receiver operating characteristic analysis found that at a conventional cut-off of 6 seconds on Alien's test had a sensitivity of 54.5%, specificity of 91.7%, and diagnostic accuracy of 78.5%. At a cut-off of 5 seconds diagnostic accuracy was maximal (79.6%), with sensitivity of 75.8% and specificity of 81.7%; 100% sensitivity occurred at a cut-off of 3 seconds, with specificity of 27% and diagnostic accuracy of 52%. Conclusions. At no cut-off point does Alien's test perform satisfactorily as a discriminatory test. It should be replaced by more objective tests, such as Doppler ultrasound. (C) 2000 by The Society of Thoracic Surgeons.