The rational clinical examination. Does this patient have aortic regurgitation? Export

@article{citeulike:248895, abstract = {OBJECTIVE: To review evidence as to the precision and accuracy of clinical examination for aortic regurgitation (AR). METHODS: We conducted a structured MEDLINE search of English-language articles (January 1966-July 1997), manually reviewed all reference lists of potentially relevant articles, and contacted authors of relevant studies for additional information. Each study (n = 16) was independently reviewed by both authors and graded for methodological quality. RESULTS: Most studies assessed cardiologists as examiners. Cardiologists' precision for detecting diastolic murmurs was moderate using audiotapes (kappa = 0.51) and was good in the clinical setting (simple agreement, 94\%). The most useful finding for ruling in AR is the presence of an early diastolic murmur (positive likelihood ratio [LR], 8.8-32.0 [95\% confidence interval [CI], 2.8-32 to 16-63] for detecting mild or greater AR and 4.0-8.3 [95\% CI, 2.5-6.9 to 6.2-11] for detecting moderate or greater AR) (2 grade A studies). The most useful finding for ruling out AR is the absence of early diastolic murmur (negative LR, 0.2-0.3 [95\% CI, 0.1-0.3 to 0.2-0.4) for mild or greater AR and 0.1 [95\% CI, 0.0-0.3] for moderate or greater AR) (2 grade A studies). Except for a test evaluating the response to transient arterial occlusion (positive LR, 8.4 [95\% CI, 1.3-81.0]; negative LR, 0.3 [95\% CI, 0.1-0.8]), most signs display poor sensitivity and specificity for AR. CONCLUSION: Clinical examination by cardiologists is accurate for detecting AR, but not enough is known about the examinations of less-expert clinicians.}, address = {Department of Medicine, University of Toronto and the University Health Network, Ontario, Canada.}, author = {Choudhry, N. K. and Etchells, E. E.}, citeulike-article-id = {248895}, citeulike-linkout-0 = {http://view.ncbi.nlm.nih.gov/pubmed/10376577}, citeulike-linkout-1 = {http://www.hubmed.org/display.cgi?uids=10376577}, day = {16}, issn = {0098-7484}, journal = {JAMA}, keywords = {aortic, examination, rational, regurgitation}, month = {June}, number = {23}, pages = {2231--2238}, posted-at = {2005-07-07 15:18:03}, priority = {0}, title = {The rational clinical examination. Does this patient have aortic regurgitation?}, url = {http://view.ncbi.nlm.nih.gov/pubmed/10376577}, volume = {281}, year = {1999} }

TY - JOUR ID - citeulike:248895 L3 - citeulike-article-id:248895 N2 - OBJECTIVE: To review evidence as to the precision and accuracy of clinical examination for aortic regurgitation (AR). METHODS: We conducted a structured MEDLINE search of English-language articles (January 1966-July 1997), manually reviewed all reference lists of potentially relevant articles, and contacted authors of relevant studies for additional information. Each study (n = 16) was independently reviewed by both authors and graded for methodological quality. RESULTS: Most studies assessed cardiologists as examiners. Cardiologists' precision for detecting diastolic murmurs was moderate using audiotapes (kappa = 0.51) and was good in the clinical setting (simple agreement, 94%). The most useful finding for ruling in AR is the presence of an early diastolic murmur (positive likelihood ratio [LR], 8.8-32.0 [95% confidence interval [CI], 2.8-32 to 16-63] for detecting mild or greater AR and 4.0-8.3 [95% CI, 2.5-6.9 to 6.2-11] for detecting moderate or greater AR) (2 grade A studies). The most useful finding for ruling out AR is the absence of early diastolic murmur (negative LR, 0.2-0.3 [95% CI, 0.1-0.3 to 0.2-0.4) for mild or greater AR and 0.1 [95% CI, 0.0-0.3] for moderate or greater AR) (2 grade A studies). Except for a test evaluating the response to transient arterial occlusion (positive LR, 8.4 [95% CI, 1.3-81.0]; negative LR, 0.3 [95% CI, 0.1-0.8]), most signs display poor sensitivity and specificity for AR. CONCLUSION: Clinical examination by cardiologists is accurate for detecting AR, but not enough is known about the examinations of less-expert clinicians. IS - 23 JF - JAMA SN - 0098-7484 AD - Department of Medicine, University of Toronto and the University Health Network, Ontario, Canada. EP - 2238 TI - The rational clinical examination. Does this patient have aortic regurgitation? VL - 281 SP - 2231 KW - aortic KW - examination KW - rational KW - regurgitation AU - Choudhry, NK AU - Etchells, EE PY - 1999/06/16/ UR - http://view.ncbi.nlm.nih.gov/pubmed/10376577 ER -