Physical examination in the care of medical inpatients: an observational study

Reilly, Brendan M.

doi:10.1016/s0140-6736(03)14464-9

Cited by 191 publications

(120 citation statements)

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“…Despite the evidence that supports the role of the physical examination (PE) in the assessment of a patient's disease 1,2 , there is considerable controversy as to whether the PE has outlived its usefulness. Some suggest that imaging may provide a more direct view into the body and prevent errors 3 .…”

Section: Introductionmentioning

confidence: 99%

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

Benbassat

Baumal

2010

J GEN INTERN MED

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Section: Introductionmentioning

confidence: 99%

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

Benbassat

Baumal

2010

J GEN INTERN MED

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“…A thorough physical examination in combination with the history is the primary source of initial information for any clinician1, 2 and influences decision making for further diagnostic and therapeutic intervention 3. Examinations should therefore have good reliability (how well can patients be distinguished from each other), high agreement (low measurement error for repeated assessments)4 and results of the examination should be valid (accurate) 5.…”

mentioning

confidence: 99%

Rater Agreement on Gait Assessment during Neurologic Examination of Horses

Olsen

Dunkel

Barker

et al. 2014

Veterinary Internal Medicne

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BackgroundReproducible and accurate recognition of presence and severity of ataxia in horses with neurologic disease is important when establishing a diagnosis, assessing response to treatment, and making recommendations that might influence rider safety or a decision for euthanasia.ObjectivesTo determine the reproducibility and validity of the gait assessment component in the neurologic examination of horses.AnimalsTwenty‐five horses referred to the Royal Veterinary College Equine Referral Hospital for neurological assessment (n = 15), purchased (without a history of gait abnormalities) for an unrelated study (n = 5), or donated because of perceived ataxia (n = 5).MethodsUtilizing a prospective study design; a group of board‐certified medicine (n = 2) and surgery (n = 2) clinicians and residents (n = 2) assessed components of the equine neurologic examination (live and video recorded) and assigned individual and overall neurologic gait deficit grades (0–4). Inter‐rater agreement and assessment‐reassessment reliability were quantified using intraclass correlation coefficients (ICC).ResultsThe ICCs of the selected components of the neurologic examination ranged from 0 to 0.69. “Backing up” and “recognition of mistakes over obstacle” were the only components with an ICC > 0.6. Assessment‐reassessment agreement was poor to fair. The agreement on gait grading was good overall (ICC = 0.74), but poor for grades ≤ 1 (ICC = 0.08) and fair for ataxia grades ≥ 2 (ICC = 0.43). Clinicians with prior knowledge of a possible gait abnormality were more likely to assign a grade higher than the median grade.Conclusion and Clinical ImportanceClinicians should be aware of poor agreement even between skilled observers of equine gait abnormalities, especially when the clinical signs are subtle.

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“…PE provides information that is critical to accurate diagnosis and can potentially save costs through decreased testing. [1][2][3][4] However, published reports have lamented the inadequacy of the PE skills of practicing clinicians, [5][6][7] and the use of advanced diagnostic tests continues to rise on an annual basis. 8 Although training in PE is a core element of undergraduate medical education (UME), it is irregularly taught in graduate medical education (GME).…”

Section: Introductionmentioning

confidence: 99%