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Accuracy and reliability of physical signs in the diagnosis of pleural effusion
Summary Although pleural effusion is a common disorder among patients presenting with respiratory symptoms, there is limited evidence on the accuracy and reliability of symptoms and signs for the diagnosis of pleural effusion. In our study, conducted at a rural hospital in India, two physicians, bli...
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Published in: | Respiratory medicine 2007-03, Vol.101 (3), p.431-438 |
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description | Summary Although pleural effusion is a common disorder among patients presenting with respiratory symptoms, there is limited evidence on the accuracy and reliability of symptoms and signs for the diagnosis of pleural effusion. In our study, conducted at a rural hospital in India, two physicians, blind to history and chest radiograph findings, and to each other's results, independently evaluated 278 patients (196 men), aged 12 and older, admitted with respiratory symptoms. We did a blind and independent comparison of physical signs (asymmetric chest expansion, vocal fremitus, percussion note, breath sounds, crackles, vocal resonance and auscultatory percussion) with the reference standard (chest radiograph). We measured diagnostic accuracy by computing sensitivity, specificity, and likelihood ratios (LRs), and inter-observer reliability by using kappa ( κ ) statistic. We performed multivariate analysis to identify the clinical signs that independently predict pleural effusion. The prevalence of pleural effusion was 21% (57/278). The LRs of positive signs ranged from 1.48 to 8.14 and their 95% confidence intervals (CIs) excluded 1. Except for pleural rub, the LRs for negative signs ranged between 0.13 and 0.71. The interobserver agreement was excellent for chest expansion, vocal fremitus, percussion and breath sounds ( κ 0.84–0.89) and good for vocal resonance, crackles and auscultatory percussion ( κ 0.68–0.78). The independent predictors of pleural effusion were asymmetric chest expansion (odds ratio [OR] 5.22, 95% CI 2.06–13.23), and dull percussion note (OR 12.80, 95% CI 4.23–38.70). For the final multivariate model, the area under receiver operating characteristic curve (ROC curve) was 0.88. In conclusion, our data suggest that physical signs may be helpful to rule out but not rule in pleural effusion. |
doi_str_mv | 10.1016/j.rmed.2006.07.014 |
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In our study, conducted at a rural hospital in India, two physicians, blind to history and chest radiograph findings, and to each other's results, independently evaluated 278 patients (196 men), aged 12 and older, admitted with respiratory symptoms. We did a blind and independent comparison of physical signs (asymmetric chest expansion, vocal fremitus, percussion note, breath sounds, crackles, vocal resonance and auscultatory percussion) with the reference standard (chest radiograph). We measured diagnostic accuracy by computing sensitivity, specificity, and likelihood ratios (LRs), and inter-observer reliability by using kappa ( κ ) statistic. We performed multivariate analysis to identify the clinical signs that independently predict pleural effusion. The prevalence of pleural effusion was 21% (57/278). The LRs of positive signs ranged from 1.48 to 8.14 and their 95% confidence intervals (CIs) excluded 1. Except for pleural rub, the LRs for negative signs ranged between 0.13 and 0.71. The interobserver agreement was excellent for chest expansion, vocal fremitus, percussion and breath sounds ( κ 0.84–0.89) and good for vocal resonance, crackles and auscultatory percussion ( κ 0.68–0.78). The independent predictors of pleural effusion were asymmetric chest expansion (odds ratio [OR] 5.22, 95% CI 2.06–13.23), and dull percussion note (OR 12.80, 95% CI 4.23–38.70). For the final multivariate model, the area under receiver operating characteristic curve (ROC curve) was 0.88. In conclusion, our data suggest that physical signs may be helpful to rule out but not rule in pleural effusion.</description><identifier>ISSN: 0954-6111</identifier><identifier>EISSN: 1532-3064</identifier><identifier>DOI: 10.1016/j.rmed.2006.07.014</identifier><identifier>PMID: 16965906</identifier><language>eng</language><publisher>Oxford: Elsevier Ltd</publisher><subject>Accuracy ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Auscultation ; Biological and medical sciences ; Female ; Humans ; India - epidemiology ; Male ; Medical diagnosis ; Medical sciences ; Middle Aged ; Observer Variation ; Pediatrics ; Percussion ; Physical examination ; Physical Examination - methods ; Pleural effusion ; Pleural Effusion - diagnosis ; Pleural Effusion - epidemiology ; Pleural Effusion - physiopathology ; Pneumology ; Prevalence ; Pulmonary/Respiratory ; Reproducibility of Results ; Respiratory distress syndrome ; Respiratory Sounds - diagnosis ; Respiratory Sounds - physiopathology ; Respiratory system : syndromes and miscellaneous diseases ; Rural Health ; Sensitivity ; Sensitivity and Specificity ; Signs ; Specificity ; Vibration ; Voice - physiology</subject><ispartof>Respiratory medicine, 2007-03, Vol.101 (3), p.431-438</ispartof><rights>Elsevier Ltd</rights><rights>2006 Elsevier Ltd</rights><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c511t-944261c6e1a2b256f7ae1953c12c2d1a86c67a4904f77dc4faf8d4b0757853653</citedby><cites>FETCH-LOGICAL-c511t-944261c6e1a2b256f7ae1953c12c2d1a86c67a4904f77dc4faf8d4b0757853653</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18554098$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16965906$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kalantri, Shriprakash</creatorcontrib><creatorcontrib>Joshi, Rajnish</creatorcontrib><creatorcontrib>Lokhande, Trunal</creatorcontrib><creatorcontrib>Singh, Amandeep</creatorcontrib><creatorcontrib>Morgan, Maureen</creatorcontrib><creatorcontrib>Colford, John M</creatorcontrib><creatorcontrib>Pai, Madhukar</creatorcontrib><title>Accuracy and reliability of physical signs in the diagnosis of pleural effusion</title><title>Respiratory medicine</title><addtitle>Respir Med</addtitle><description>Summary Although pleural effusion is a common disorder among patients presenting with respiratory symptoms, there is limited evidence on the accuracy and reliability of symptoms and signs for the diagnosis of pleural effusion. In our study, conducted at a rural hospital in India, two physicians, blind to history and chest radiograph findings, and to each other's results, independently evaluated 278 patients (196 men), aged 12 and older, admitted with respiratory symptoms. We did a blind and independent comparison of physical signs (asymmetric chest expansion, vocal fremitus, percussion note, breath sounds, crackles, vocal resonance and auscultatory percussion) with the reference standard (chest radiograph). We measured diagnostic accuracy by computing sensitivity, specificity, and likelihood ratios (LRs), and inter-observer reliability by using kappa ( κ ) statistic. We performed multivariate analysis to identify the clinical signs that independently predict pleural effusion. The prevalence of pleural effusion was 21% (57/278). The LRs of positive signs ranged from 1.48 to 8.14 and their 95% confidence intervals (CIs) excluded 1. Except for pleural rub, the LRs for negative signs ranged between 0.13 and 0.71. The interobserver agreement was excellent for chest expansion, vocal fremitus, percussion and breath sounds ( κ 0.84–0.89) and good for vocal resonance, crackles and auscultatory percussion ( κ 0.68–0.78). The independent predictors of pleural effusion were asymmetric chest expansion (odds ratio [OR] 5.22, 95% CI 2.06–13.23), and dull percussion note (OR 12.80, 95% CI 4.23–38.70). For the final multivariate model, the area under receiver operating characteristic curve (ROC curve) was 0.88. In conclusion, our data suggest that physical signs may be helpful to rule out but not rule in pleural effusion.</description><subject>Accuracy</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Auscultation</subject><subject>Biological and medical sciences</subject><subject>Female</subject><subject>Humans</subject><subject>India - epidemiology</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Observer Variation</subject><subject>Pediatrics</subject><subject>Percussion</subject><subject>Physical examination</subject><subject>Physical Examination - methods</subject><subject>Pleural effusion</subject><subject>Pleural Effusion - diagnosis</subject><subject>Pleural Effusion - epidemiology</subject><subject>Pleural Effusion - physiopathology</subject><subject>Pneumology</subject><subject>Prevalence</subject><subject>Pulmonary/Respiratory</subject><subject>Reproducibility of Results</subject><subject>Respiratory distress syndrome</subject><subject>Respiratory Sounds - diagnosis</subject><subject>Respiratory Sounds - physiopathology</subject><subject>Respiratory system : syndromes and miscellaneous diseases</subject><subject>Rural Health</subject><subject>Sensitivity</subject><subject>Sensitivity and Specificity</subject><subject>Signs</subject><subject>Specificity</subject><subject>Vibration</subject><subject>Voice - physiology</subject><issn>0954-6111</issn><issn>1532-3064</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><recordid>eNp9kk2L1TAUhoMoznX0D7iQguiu9aTNRwsyMAx-wcAsVHAXctOTmVx702tOK_Tfm3ovDszCVRZ53sObJ4exlxwqDly921Vpj31VA6gKdAVcPGIbLpu6bECJx2wDnRSl4pyfsWdEOwDohICn7IyrTskO1IbdXDo3J-uWwsa-SDgEuw1DmJZi9MXhbqHg7FBQuI1UhFhMd1j0wd7GkQL9RQbM8aFA72cKY3zOnng7EL44nefs-8cP364-l9c3n75cXV6XTnI-lblHrbhTyG29raXy2iLvZON47eqe21Y5pa3oQHiteye89W0vtqClbmWjZHPO3h7nHtL4a0aazD6Qw2GwEceZjGq7rtG8zeDrB-BunFPM3QyHRoJQQulM1UfKpZEooTeHFPY2LRkyq2yzM6tss8o2oE2WnUOvTqPn7Xr3L3Kym4E3J8BS1uiTjS7QPddKKaBbO74_cpiN_Q6YDLmA0WEfErrJ9GP4f4-LB3E3hLh-3E9ckO7fa6g2YL6ua7FuBSiApm1_NH8ApR6wsw</recordid><startdate>20070301</startdate><enddate>20070301</enddate><creator>Kalantri, Shriprakash</creator><creator>Joshi, Rajnish</creator><creator>Lokhande, Trunal</creator><creator>Singh, Amandeep</creator><creator>Morgan, Maureen</creator><creator>Colford, John M</creator><creator>Pai, Madhukar</creator><general>Elsevier Ltd</general><general>Elsevier</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7U9</scope><scope>ASE</scope><scope>FPQ</scope><scope>H94</scope><scope>K6X</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20070301</creationdate><title>Accuracy and reliability of physical signs in the diagnosis of pleural effusion</title><author>Kalantri, Shriprakash ; Joshi, Rajnish ; Lokhande, Trunal ; Singh, Amandeep ; Morgan, Maureen ; Colford, John M ; Pai, Madhukar</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c511t-944261c6e1a2b256f7ae1953c12c2d1a86c67a4904f77dc4faf8d4b0757853653</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Accuracy</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Auscultation</topic><topic>Biological and medical sciences</topic><topic>Female</topic><topic>Humans</topic><topic>India - epidemiology</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Observer Variation</topic><topic>Pediatrics</topic><topic>Percussion</topic><topic>Physical examination</topic><topic>Physical Examination - methods</topic><topic>Pleural effusion</topic><topic>Pleural Effusion - diagnosis</topic><topic>Pleural Effusion - epidemiology</topic><topic>Pleural Effusion - physiopathology</topic><topic>Pneumology</topic><topic>Prevalence</topic><topic>Pulmonary/Respiratory</topic><topic>Reproducibility of Results</topic><topic>Respiratory distress syndrome</topic><topic>Respiratory Sounds - diagnosis</topic><topic>Respiratory Sounds - physiopathology</topic><topic>Respiratory system : syndromes and miscellaneous diseases</topic><topic>Rural Health</topic><topic>Sensitivity</topic><topic>Sensitivity and Specificity</topic><topic>Signs</topic><topic>Specificity</topic><topic>Vibration</topic><topic>Voice - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kalantri, Shriprakash</creatorcontrib><creatorcontrib>Joshi, Rajnish</creatorcontrib><creatorcontrib>Lokhande, Trunal</creatorcontrib><creatorcontrib>Singh, Amandeep</creatorcontrib><creatorcontrib>Morgan, Maureen</creatorcontrib><creatorcontrib>Colford, John M</creatorcontrib><creatorcontrib>Pai, Madhukar</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Virology and AIDS Abstracts</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Respiratory medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kalantri, Shriprakash</au><au>Joshi, Rajnish</au><au>Lokhande, Trunal</au><au>Singh, Amandeep</au><au>Morgan, Maureen</au><au>Colford, John M</au><au>Pai, Madhukar</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Accuracy and reliability of physical signs in the diagnosis of pleural effusion</atitle><jtitle>Respiratory medicine</jtitle><addtitle>Respir Med</addtitle><date>2007-03-01</date><risdate>2007</risdate><volume>101</volume><issue>3</issue><spage>431</spage><epage>438</epage><pages>431-438</pages><issn>0954-6111</issn><eissn>1532-3064</eissn><abstract>Summary Although pleural effusion is a common disorder among patients presenting with respiratory symptoms, there is limited evidence on the accuracy and reliability of symptoms and signs for the diagnosis of pleural effusion. In our study, conducted at a rural hospital in India, two physicians, blind to history and chest radiograph findings, and to each other's results, independently evaluated 278 patients (196 men), aged 12 and older, admitted with respiratory symptoms. We did a blind and independent comparison of physical signs (asymmetric chest expansion, vocal fremitus, percussion note, breath sounds, crackles, vocal resonance and auscultatory percussion) with the reference standard (chest radiograph). We measured diagnostic accuracy by computing sensitivity, specificity, and likelihood ratios (LRs), and inter-observer reliability by using kappa ( κ ) statistic. We performed multivariate analysis to identify the clinical signs that independently predict pleural effusion. The prevalence of pleural effusion was 21% (57/278). The LRs of positive signs ranged from 1.48 to 8.14 and their 95% confidence intervals (CIs) excluded 1. Except for pleural rub, the LRs for negative signs ranged between 0.13 and 0.71. The interobserver agreement was excellent for chest expansion, vocal fremitus, percussion and breath sounds ( κ 0.84–0.89) and good for vocal resonance, crackles and auscultatory percussion ( κ 0.68–0.78). The independent predictors of pleural effusion were asymmetric chest expansion (odds ratio [OR] 5.22, 95% CI 2.06–13.23), and dull percussion note (OR 12.80, 95% CI 4.23–38.70). For the final multivariate model, the area under receiver operating characteristic curve (ROC curve) was 0.88. In conclusion, our data suggest that physical signs may be helpful to rule out but not rule in pleural effusion.</abstract><cop>Oxford</cop><pub>Elsevier Ltd</pub><pmid>16965906</pmid><doi>10.1016/j.rmed.2006.07.014</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Accuracy Adolescent Adult Aged Aged, 80 and over Auscultation Biological and medical sciences Female Humans India - epidemiology Male Medical diagnosis Medical sciences Middle Aged Observer Variation Pediatrics Percussion Physical examination Physical Examination - methods Pleural effusion Pleural Effusion - diagnosis Pleural Effusion - epidemiology Pleural Effusion - physiopathology Pneumology Prevalence Pulmonary/Respiratory Reproducibility of Results Respiratory distress syndrome Respiratory Sounds - diagnosis Respiratory Sounds - physiopathology Respiratory system : syndromes and miscellaneous diseases Rural Health Sensitivity Sensitivity and Specificity Signs Specificity Vibration Voice - physiology |
title | Accuracy and reliability of physical signs in the diagnosis of pleural effusion |
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