Narrative Review: Should Teaching of the Respiratory Physical Examination Be Restricted Only to Signs with Proven Reliability and Validity?

Benbassat, Jochanan; Baumal, Reuben

doi:10.1007/s11606-010-1327-8

Cited by 49 publications

(39 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In humans, a French study performed in a hospital setting with better auscultation conditions than on a farm, the performance of thoracic auscultation was poor for detection of alveolar consolidation (sensitivity = 36%) 26. The available evidence concerning the use of lung sounds in a clinical setting is a recurrent debate in the human medical literature 27, 28…”

Section: Discussionmentioning

confidence: 99%

Comparison of Thoracic Auscultation, Clinical Score, and Ultrasonography as Indicators of Bovine Respiratory Disease in Preweaned Dairy Calves

Buczinski

Forte

Francoz

et al. 2013

Veterinary Internal Medicne

131

150

View full text Add to dashboard Cite

BackgroundThe diagnostic tools for bovine respiratory disease diagnosis include clinical inspection, thoracic auscultation, and ultrasonography.HypothesisThoracic auscultation and clinical examination have limitations in the detection of lung consolidation in dairy calves.AnimalsProspective cohort of 106 preweaned calves from 13 different dairy herds (10 with a history of active bovine respiratory disease (BRD) in calves and 3 without suspected BRD problems).MethodsEach preweaned calf was clinically inspected using the Wisconsin calf respiratory scoring chart (CRSC) and treatment history was noted. Systematic thoracic auscultation and ultrasonography then were performed, the latter focusing on lung consolidation. Mortality was recorded over a 30‐day period.ResultsA total of 56 of 106 calves had ultrasonographic evidence of lung consolidation. The sensitivity of thoracic auscultation to detect consolidation was 5.9% (range, 0–16.7%). Only 41.1% (23/33) of calves with consolidated lungs had been treated previously by the producers. When adding CRSC and previous BRD treatment by the producer, sensitivity of detection increased to 71.4% (40/56). The area under the receiver operating characteristics curve was 0.809 (95% CI, 0.721–0.879) for the number of areas within the lungs with consolidation and 0.743 (95% CI, 0.648–0.823) for the maximal depth of consolidation as predictors of death within 1 month after examination. These were not significantly different (P = .06).Conclusions and Clinical ImportanceThis study shows that thoracic auscultation is of limited value in diagnosing lung consolidation in calves. Ultrasonographic assessment of the thorax could be a useful tool to assess BRD detection efficiency on dairy farms.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparison of Thoracic Auscultation, Clinical Score, and Ultrasonography as Indicators of Bovine Respiratory Disease in Preweaned Dairy Calves

Buczinski

Forte

Francoz

et al. 2013

Veterinary Internal Medicne

131

150

View full text Add to dashboard Cite

show abstract

“…Third, we did not measure agreement between observers, although a systematic review by Benbassat and Baumal 24 reported that agreement in detecting respiratory distress was fair. Campbell 25 reported that a graduate nursing student has a high reliability in detecting fear, use of accessory muscles, paradoxical breathing, and nasal flaring during weaning.…”

Section: Discussionmentioning

confidence: 99%

Association Between Rating of Respiratory Distress and Vital Signs, Severity of Illness, Intubation, and Mortality in Acutely Ill Subjects

et al. 2014

View full text Add to dashboard Cite

BACKGROUND: When deciding whether mechanical ventilation is indicated, physicians integrate their findings on physical examination in a gestalt known as respiratory distress. Despite its importance, this gestalt is poorly understood. This study aims to describe the association between the rating of the severity of respiratory distress and vital signs, severity of illness, use of mechanical ventilation, and death. A prospective observational study with 1,134 consecutive subjects with uncertain triage evaluated by a critical care consult team was carried out in a public inner city teaching hospital. METHODS: After the initial evaluation of each patient, a critical care physician rated the level of respiratory distress. We recorded vital signs, diagnosis, and laboratory results and calculated the Acute Physiology and Chronic Health Evaluation (APACHE) II score. We recorded if mechanical ventilation was initiated by 72 h and if the subject died during the hospitalization. RESULTS: The most common diagnoses were respiratory illnesses. Higher distress levels were associated with higher breathing frequency (20, 22, 27, and 30 breaths/min, P < .001) and heart rate (96, 101, 109, and 116 beats/min, P < .001) and lower S pO 2 (97, 95, 93, and 92%, P < .001). These variables explain only a small portion of the variance of distress. Distress correlated weakly with the APACHE II score (r ‫؍‬ 0.22, P ‫؍‬ .001). Blood pressure, temperature, Glasgow coma scale score, and laboratory data were unrelated to the levels of distress. However, higher levels of distress correlated with intubation rates (5, 13, 27, and 41%, P < .001). The area under the receiver operating characteristic curve for respiratory distress predicting intubation (0.72) was larger than that for breathing frequency (0.65). Distress was an independent predictor of intubation but not of death. CONCLUSIONS: A physician's rating of respiratory distress is independently predictive of intubation in 72 h. Vital signs explain only a small proportion of variance in distress; the other observations contributing to a physician's rating of distress must be determined.

show abstract

“…Previous studies have demonstrated considerable interobserver variation when patients have been examined by more than one doctor 19. This has particularly been the case for hyperresonance to percussion and diminished breath sounds 19.…”

Section: Discussionmentioning

confidence: 99%

Should chest examination be reinstated in the early diagnosis of chronic obstructive pulmonary disease?

Oshaug¹,

Halvorsen²,

Melbye³

2013

COPD

View full text Add to dashboard Cite

BackgroundAlthough proven to be associated with bronchial obstruction, chest signs are not listed among cues that should prompt spirometry in the early diagnosis of chronic obstructive pulmonary disease (COPD) in established guidelines.AimsWe aimed to explore how chest findings add to respiratory symptoms and a history of smoking in the diagnosis of COPD.MethodsIn a cross-sectional study, patients aged 40 years or older, previously diagnosed with either asthma or COPD in primary care, answered questionnaires and underwent physical chest examination and spirometry.ResultsAmong the 375 patients included, 39.7% had forced expiratory volume in 1 second/forced vital capacity <0.7. Hyperresonance to percussion was the strongest predictor of COPD, with a sensitivity of 20.8, a specificity of 97.8, and likelihood ratio of 9.5. In multivariate logistic regression, where pack-years, shortness of breath, and chest findings were among the explanatory variables, three physical chest findings were independent predictors of COPD. Hyperresonance to percussion yielded the highest odds ratio (OR = 6.7), followed by diminished breath sounds (OR = 5.0), and thirdly wheezes (OR = 2.3). These three chest signs also gave significant diagnostic information when added to shortness of breath and pack-years in receiver operating-characteristic curve analysis.ConclusionWe found that chest signs may add to respiratory symptoms and a history of smoking in the diagnosis of COPD, and we conclude that chest signs should be reinstated as cues to early diagnosis of COPD in patients 40 years or older.

show abstract

Narrative Review: Should Teaching of the Respiratory Physical Examination Be Restricted Only to Signs with Proven Reliability and Validity?

Cited by 49 publications

References 61 publications

Comparison of Thoracic Auscultation, Clinical Score, and Ultrasonography as Indicators of Bovine Respiratory Disease in Preweaned Dairy Calves

Comparison of Thoracic Auscultation, Clinical Score, and Ultrasonography as Indicators of Bovine Respiratory Disease in Preweaned Dairy Calves

Association Between Rating of Respiratory Distress and Vital Signs, Severity of Illness, Intubation, and Mortality in Acutely Ill Subjects

Should chest examination be reinstated in the early diagnosis of chronic obstructive pulmonary disease?

Contact Info

Product

Resources

About