Clinician's Palmar Comparison Method with Photographic Documentation: A Novel Visual Tool for Bedside Detection of Anemia – A Prospective Observational Study

Background: Anemia is a major public health problem in developing countries, particularly among children. Clinical assessment using pallor is widely practiced but suffers from subjectivity and lack of standardization. Introducing a visual reference may improve the diagnostic utility and reproducibility of clinical pallor assessment. Aim: To evaluate the diagnostic accuracy of the clinician’s palmar comparison method with photographic documentation for the detection of anemia, using laboratory hemoglobin estimation as the reference standard. Methods: This prospective observational validation study was conducted in the Department of Paediatrics at Kamineni Institute of Medical Sciences, Narketpally, over six months. A total of 100 participants aged ≥1 year undergoing routine hemoglobin estimation were included. Under standardized daylight conditions, side-by-side photographs of the clinician’s palm (hemoglobin 14–15 g/dL) and the patient’s palm were obtained. Pallor was graded photographically into four grades (0–3) by two independent blinded observers. Diagnostic performance parameters (sensitivity, specificity, PPV, NPV), ROC analysis, and interobserver reliability using Cohen’s kappa were calculated. Results: Anemia was present in 60% of participants. Photographic palmar pallor grading showed a significant inverse correlation with laboratory hemoglobin levels (p < 0.001). The palmar comparison method demonstrated a sensitivity of 85%, specificity of 80%, PPV of 86.4%, NPV of 78%, and an overall diagnostic accuracy of 83%. The area under the ROC curve was 0.88 (95% CI: 0.80–0.95; p < 0.001). Interobserver agreement was good (Cohen’s κ = 0.79, p < 0.001). Feasibility assessment showed high acceptability and suitability for bedside, paediatric, and low-resource settings. Conclusion: The clinician’s palmar comparison method with photographic documentation is a reliable, accurate, and feasible screening tool for anemia. It demonstrates good diagnostic performance, strong interobserver agreement, and practical applicability in low-resource and paediatric settings.