The relation of conjunctival pallor to the presence of anemia

To determine the value of conjunctival pallor in ruling in or ruling out the presence of severe anemia (hemoglobin < or = 90 g/L) and to determine the interobserver agreement in assessing this sign. Patients were prospectively assessed for pallor by at least one of three observers. All observatio...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM 1997-02, Vol.12 (2), p.102-106
Main Authors: SHETH, T. N, CHOUDHRY, N. K, BOWES, M, DETSKY, A. S
Format: Article
Language:English
Subjects:
Adult
Aged
Anemia
Anemia - diagnosis
Anemias. Hemoglobinopathies
Bayes Theorem
Biological and medical sciences
Cardiovascular disease
Color
Confidence Intervals
Conjunctiva - pathology
Diseases of red blood cells
Female
Hematologic and hematopoietic diseases
Hemoglobin
Hemoglobins - analysis
Humans
Internal medicine
Likelihood Functions
Male
Medical sciences
Middle Aged
Observer Variation
Pallor
Patients
Physical Examination - methods
Probability
Prospective Studies
Ratios
ROC Curve
Signs
Teaching hospitals
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Summary:To determine the value of conjunctival pallor in ruling in or ruling out the presence of severe anemia (hemoglobin < or = 90 g/L) and to determine the interobserver agreement in assessing this sign. Patients were prospectively assessed for pallor by at least one of three observers. All observations were made without information of the patient's hemoglobin value or of another observer's assessment. Tertiary-care, university-affiliated teaching hospital. Three hundred and two medical and surgical inpatients. Likelihood ratios (LRs) calculated for conjunctival pallor present, borderline, and absent were as follows: pallor present, LR 4.49 (95% confidence interval [CI] 1.80, 10.99); pallor borderline, LR 1.80 (95% CI 1.18, 2.62); pallor absent, LR 0.61 (95% CI 0.44, 0.80). Kappa scores of interobserver agreement between paired observers were 0.75 and 0.54. The presence of conjunctival pallor, without other information suggesting anemia, is reason enough to perform a hemoglobin determination. The absence of conjunctival pallor is not likely to be of use in ruling out severe anemia. With well-defined criteria, interobserver agreement is good to very good.
ISSN:0884-8734
1525-1497
DOI:10.1007/s11606-006-5004-x