Does This Patient Have Splenomegaly?

Grover, Steven A.; Barkun, Alan N.; Sackett, David L.

doi:10.1001/jama.1993.03510180088040

Cited by 64 publications

(38 citation statements)

References 16 publications

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“…Regarding which specific physical examination skills should be emphasized, JAMA has published an ongoing series of critical reviews entitled the "Rational Clinical Examination," [8][9][10][11][12][13][14][15][16][17][18][19] and this information can help guide the selection of specific skills that deserve emphasis. To identify those specific skills which should be targeted for improvement in instruction, we should know the skills in which physicians, residents, and medical students are least confident in their ability, as well as those skills that they view as being most important.…”

Section: Introductionmentioning

confidence: 99%

Self-Confidence in and Perceived Utility of the Physical Examination: A Comparison of Medical Students, Residents, and Faculty Internists

Fagan

Reinert

et al. 2007

J GEN INTERN MED

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BACKGROUND AND OBJECTIVES:Little is known about the differences in attitudes of medical students, Internal Medicine residents, and faculty Internists toward the physical examination. We sought to investigate these groups' self-confidence in and perceived utility of physical examination skills. DESIGN AND PARTICIPANTS:Cross-sectional survey of third-and fourth-year medical students, Internal Medicine residents, and faculty Internists at an academic teaching hospital. MEASUREMENTS:Using a 5-point Likert-type scale, respondents indicated their self-confidence in overall physical examination skill, as well as their ability to perform 14 individual skills, and how useful they felt the overall physical examination, and each skill, to be for yielding clinically important information. RESULTS:The response rate was 80% (302/376). The skills with overall mean self-confidence ratings less than "neutral" were interpreting a diastolic murmur (2.9), detecting a thyroid nodule (2.8), and the nondilated fundoscopic examination using an ophthalmoscope to assess retinal vasculature (2.5). No skills had a mean utility rating less than neutral. The skills with the greatest numerical differences between mean self-confidence and perceived utility were distinguishing between a mole and melanoma (1.5), detecting a thyroid nodule (1.4), and interpreting a diastolic murmur (1.3). Regarding overall self-confidence, third-year students' ratings (3.3) were similar to those of first-year residents (3.4; p=.95) but less than those of fourth-year students (3.8; p=.002), upper-level residents (3.7; p=.01), and faculty Internists (3.9; p<.001).CONCLUSIONS: Self-confidence in the physical exam does not necessarily increase at each stage of training. The differences found between self-confidence and perceived utility for a number of skills suggest important areas for educational interventions.

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Section: Introductionmentioning

confidence: 99%

Self-Confidence in and Perceived Utility of the Physical Examination: A Comparison of Medical Students, Residents, and Faculty Internists

Fagan

Reinert

et al. 2007

J GEN INTERN MED

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“…Os objetivos dessa série de artigos foram buscar a identificação dos achados de anamnese e exame físico que são úteis ou inúteis baseados na qualidade da evidência clínica, além de estimular novas pesquisas na área. Essa série de artigos do JAMA ainda continua embora com uma frequência de publicação mais baixa sendo publicados dois artigos em 2013, avaliou, a luz das melhores evidências, vários dados de anamnese e manobras do exame físico incluindo uma avaliação baseada em evidências das lombalgias, da esplenomegalia, da palpação do fígado, da pressão venosa central, do melanoma, do infarto do miocárdio, do aneurisma de aorta abdominal, da hipovolemia, da regurgitação aórtica, da meningite aguda, do câncer de mama, do baqueteamento de dedos, da síndrome do túnel do carpo e da lesão de ligamentos do joelho, entre outros temas [10][11][12][13][14][15][16][17][18][19][20][21][22] . Além dessa série do JAMA, outros autores têm publicado artigos avaliando de forma científica a arte da anamnese e do exame físico em várias áreas médicas, mas ainda são poucos os estudos nessa área [23][24][25][26][27][28][29][30][31] .…”

Section: Valorização Da Anamnese E Do Exame Físicounclassified

Anamnese, exame clínico e exames complementares como testes diagnósticos

Benseñor

2013

Rev. Med. (São Paulo)

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Rev Med (São Paulo (1) verdadeiro-positivo, quando positivo na presença da doença; (2) falso-positivo, se o teste revelar-se positivo em paciente sem doença; (3) verdadeiro-negativo, se o teste é negativo e o indivíduo não tem doença; (4) falso-negativo, se o teste é negativo na presença de doença. A partir desses dados pode-se calcular a sensibilidade, a especificidade, o valor preditivo positivo e negativo e as razões de verossimilhança positiva e negativa. A interpretação das informações coletadas na anamnese e no exame clínico como testes diagnósticos refina seu papel na investigação clínica em relação ao diagnóstico final. Os gastos com saúde são finitos e limitados ao orçamento público, e mesmo em um hospital terciário há restrições à realização desses exames causada pelo desbalanço entre demanda e capacidade de realização dos exames. A utilização desse tipo de ferramenta permite priorizar os pacientes que mais precisarão do exame complementar, e como consequência, leva a um melhor gerenciamento do sistema de saúde como um todo. DESCRItORES:Anamnese; Exames médicos/prevenção & controle; Exame físico; Testes diagnósticos de rotina. ABStRACt:The main tools that a physician uses for medical diagnosis are clinical history and clinical examination. Hampton et al. in 1970 showed in 80 English outpatients that clinical history was responsible by 82.5% of medical diagnosis, clinical examination for more 8.75%, and other tests for more 8.75%. Study done in HCFMUSP showed that clinical history was responsible for 40.4% of medical diagnosis, clinical examination for more 29.4% e other tests for more 29.5%. A laboratory test or image procedure always brings information about sensitivity and specificity of the method. However, it not common to teach the sensitivity or specificity of information obtained at clinical history or clinical examination. Results from a diagnostic test compared to a gold-standard permit the contruction of a 2 x 2 table with four possible interpretations of the results: (1) true positive, when test is positive in the presence of disease; (2) false-positive when it is positive in the absence of disease; (3) true negative when test is negative in the absence of disease; false-negative, when test is negative in the presence of disease. Based on these possibilities it is possible to calculate sensititivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. Interpretation of the information collected as part of clinical history or examination as diagnostic tests refine their role in the clinical investigation and final diagnosis. Health costs are finite and limited to the public budget, and even in a tertiary care facility there are restrictions to the execution of these tests caused by an imbalance among demand and the capacity to perform the tests. The use of this type of tool permit the use of the tests in patients with the greatest necessity of them, and the main consequence is a better management of the health system as a whole.

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“…Palpation and percussion tests of the spleen are routinely used in the physical examination, yet to our knowledge, there is no consensus on the diagnostic accuracy of these tests. To date, diagnostic accuracy of clinical tests for the spleen was reviewed on three separate occasions, in English, by Yang et al in 1991, 11 Grover et al in 1993, 12 and Brown and colleagues in 2011. 13 They concluded that these tests lacked sensitivity, 11,12 and all three studies recommended further and more comprehensive investigation.…”

Section: Introductionmentioning

confidence: 99%

“…To date, diagnostic accuracy of clinical tests for the spleen was reviewed on three separate occasions, in English, by Yang et al in 1991, 11 Grover et al in 1993, 12 and Brown and colleagues in 2011. 13 They concluded that these tests lacked sensitivity, 11,12 and all three studies recommended further and more comprehensive investigation. [11][12][13] It is worth noting that all three of these reviews were not performed in a systematic manner, nor did any of the three critically appraise the studies included in the reviews for risk of bias or quality.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of clinical tests for the detection of splenomegaly

Stewart

Derck

Long

et al. 2013

Physical Therapy Reviews

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Background: Due to common pain referral patterns, splenomegaly may present similarly to other conditions commonly seen in the physical therapy setting, and may become deadly if undetected. Therefore, when considering a differential diagnosis for left upper quadrant pain and the appropriateness of physical therapy intervention, it is imperative to screen for splenomegaly. Objective: To summarize the research on the diagnostic accuracy of clinical examination tests for the detection of splenomegaly to determine if physical therapists and other health care providers can rely upon these tests to screen for splenomegaly. Methods: A computer-based search strategy was conducted, using PubMed (MESH terms), Cochrane Central Register of Controlled Trials, ProQuest Nursing & Allied Health Source, SPORTDiscus, CINAHL, and SCOPUS databases (key words). Selection required: (1) an assessment of individual clinical measures of splenomegaly, (2) diagnostic accuracy measures for clinical tests, (3) an acceptable reference standard for comparison, and (4) a case-control or case-based case-control design. Electronic and hand search limits included English-written and human studies. Results: The studies included Nixon's percussion, Castell's percussion, percussion of Traube's space, bimanual palpation of the spleen, ballottement of the spleen, Middleton's maneuver, and the combination of percussion and palpation testing. For each clinical test from each study, diagnostic accuracy measures were reported as well as reliability, when available. Quality scores were tabulated for each study using the QUADAS instrument and studies were dichotomized into high ( §10/14) or low (,10/14) quality based on QUADAS scores. Thirteen articles qualified for inclusion, of which four were identified as high quality. When comparing high quality studies, palpation techniques yielded specificity values of 82-93 and sensitivity values of 31-85.6, whereas percussion techniques presented with lower values in both specificity (32.6-87) and sensitivity (22-85.7). Conclusion: There is moderate evidence for the use of palpation tests for ruling in splenomegaly and limited evidence to support the use of palpation or percussion techniques for ruling out this condition. More high quality studies are needed.

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Does This Patient Have Splenomegaly?

Cited by 64 publications

References 16 publications

Self-Confidence in and Perceived Utility of the Physical Examination: A Comparison of Medical Students, Residents, and Faculty Internists

Self-Confidence in and Perceived Utility of the Physical Examination: A Comparison of Medical Students, Residents, and Faculty Internists

Anamnese, exame clínico e exames complementares como testes diagnósticos

Diagnostic accuracy of clinical tests for the detection of splenomegaly

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