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Results for “PHYSICAL EXAMINATION”

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PubMed2000

Predicting electrodiagnostic outcome in patients with upper limb symptoms: are the history and physical examination helpful?

OBJECTIVE: To determine the effectiveness of medical history and physical examination in predicting electrodiagnostic outcome in patients with suspected cervical radiculopathy. METHODS: Data on 183 subjects prospectively collected at five different electrodiagnostic laboratories were analyzed (96 cervical radiculopathies, 45 normal studies, and 42 abnormal electrodiagnostic findings other than radiculopathy). The sensitivity, specificity, positive predictive value, negative predictive value, and odds ratios were determined for symptoms and neurologic signs. RESULTS: Symptoms of numbness, weakness, and tingling were associated with twice the probability of having abnormal electrodiagnostic study results in general, yet were not helpful in identifying a cervical radiculopathy. All single and combined physical examination components had poor sensitivities, with the exception of weakness, but much higher specificities. Patients with either weakness or reduced reflexes on physical examination were up to five times more likely to have abnormal electrodiagnostic findings. In subjects with any abnormal neurologic sign, the sensitivity improved to 84%, the positive predictive value was 79%, but the specificity was low (44%). Of those subjects with normal physical examination results, almost one half had an abnormal electrodiagnostic study result (negative predictive value 52%). CONCLUSIONS: In a population of patients with suspected cervical radiculopathy, medical history and physical examination are helpful yet not sufficient to predict the electrodiagnostic outcome.

Adolescent↗

PubMed1999

Should a history section be included on the National Youth Sports Program preparticipation physical examination?

The National Youth Sports Program (NYSP) is an annual event sponsored by the National Collegiate Athletic Association that provides structured sports and enrichment programs to youth of low socioeconomic status. As part of the program, youths undergo a free medical examination that uses a physical examination checklist but does not include a section on medical history. To determine what additional information a medical history would provide, a history form was used in conjunction with the regular preparticipation examination for participants in the 1996 NYSP at the North Carolina Agricultural and Technical State University. The history form provided information such as family history of sudden death, personal history of asthma or bone injury, and whether participants took medications or used corrective lenses. Seventy-nine percent of the completed history forms documented a positive response to at least one question. Of these, only 5% had physical findings on examination. Conversely, 15% of participants had physical findings that were not reported on the history form. Because much of what is discovered by a medical history often is not found on physical examination and because history information can be used to prevent the occurrence of an accident or illness, this study suggests that the use of such a form is beneficial in providing a more comprehensive screening.

Adolescent↗

PubMed2005

Use of annual physical examinations by aging Chinese Canadians.

OBJECTIVES: This study identified predictors of use of annual physical examination by aging Chinese Canadians. METHODS: Data were collected from a random sample of 2,272 Chinese Canadians aged 55 and older. Based on the Andersen-Newman service utilization framework, hierarchical logistic regression analysis was used to examine the predictors of annual physical examination use. RESULTS: Predicting factors of annual physical health examination use were marital status, gender, length of residency in Canada, Chinese ethnic identity, social support, number of illnesses, dependency in instrumental activities of daily living (IADL), and depressive symptoms. DISCUSSION: Findings showed importance in targeting identified groups for preventive health education. Strengthened ethnic identity may serve to enhance one's social support network, which in turn facilitates the use of annual physical examinations. There may be awareness within the Chinese cultural network that builds education and attentiveness to preventive health care. The misconceptions about annual physical examinations were also discussed.

Activities of Daily Living↗

PubMed2003

[Significance of physical examination and radiography of the pelvis during treatment in the shock emergency room].

AIM: Physical examination and radiography of the pelvis is part of most routine protocols in the emergency room (ER) management of blunt trauma patients. The purpose of this study was to determine the usefulness of these diagnostic tests with respect to diagnostic accuracy, therapeutic consequences, and prognosis in severely injured patients. METHOD: In a prospective study including all trauma patients admitted to the ER, physical examination and clinical management were evaluated. All patients underwent physical examination of the pelvis and were grouped into two categories: patients without (group I) and with (group II) clinical pelvic instability. A comparison between these two groups was made for standard demographic data, indices of shock, diagnostic and therapeutic procedures, and results. RESULTS: During a 45-month period a total of 1160 patients were enrolled: 979 subjects (ISS 21+/-16) with blunt trauma were included in this analysis. Of these, 929 patients had negative (group I) and 51 (group II) positive examination results for clinical stability of the pelvis. When comparing these two groups, group II patients had a higher injury severity score, higher incidence of shock with a lower initial systolic blood pressure, a lower initial hemoglobin, and a higher rate of associated severe chest and abdominal injuries (AIS > or = 3). Among the 51 patients with abnormal pelvis instability, there were 6 type A, 16 type B, and 27 type C fractures, whereas in two cases no pelvic fracture could be found. Of the 928 patients without positive clinical signs, 866 (93%) had no pelvic fracture. There were 40 type A, 19 type B, and 3 type C fractures missed on clinical examination. The physical examination had a sensitivity of 44% and specificity of 99% for detecting pelvic fracture. A comparison between groups I and II showed the patients with positive physical pelvic examination to have greater transfusion requirements and a higher rate of surgical intervention for pelvic stabilization and blood control. CONCLUSION: The clinical diagnosis of pelvic instability should result in an immediate order for blood products, taking surgical intervention into account. Pelvic radiographs in the ER are required for early surgical management. In patients with negative pelvis examination results, a routine pelvic radiograph is recommended because clinical examination cannot reliably rule out surgically significant pelvic fractures (20%) in the severely injured and intubated blunt trauma patient.

Adult↗

PubMed1992

Evaluation of chest pain. Back to the basics of history taking and physical examination.

Although careful history taking and physical examination seem to have been supplanted in some parts of modern medicine by expensive and high-tech laboratory tests, evaluation of chest pain is an exception. It still depends on careful attention to the basics of a directed line of history taking and physical examination. Careful correlation of the details elicited with the pathophysiology of myocardial ischemia leads the astute clinician through the maze of various causes of chest pain to the proper final diagnosis.

Angina Pectoris↗

PubMed2002

Correlation between abnormal cardiac physical examination and echocardiographic findings in neonates with Down syndrome.

Congenital heart disease is present in 40-50% of individuals with Down syndrome. Although cardiovascular evaluation is a standard component of the diagnostic work-up in patients with Down syndrome, the value of routine neonatal echocardiography in this population is debated. We studied 114 neonates with Down syndrome who underwent both cardiac physical examination and echocardiography in the neonatal period to assess the accuracy of physical examination for identifying cardiovascular anomalies in this population. We retrospectively reviewed physical examination records and echocardiogram reports in 114 neonates with Down syndrome and trisomy 21. A patient was considered to have an abnormal cardiac physical examination if there was a pathologic cardiac murmur and/or cyanosis or an abnormal systemic arterial oxygen saturation. The median age at the time of physical examination was 2 days (1-30 days). Physical examination findings suggestive of cardiovascular pathology were noted in 77 patients (68%), with an abnormal cardiac murmur in 34 (30%), cyanosis and/or a pulse oximeter reading of < or = 92% in 35 (31%), and both in 7 (6%). The echocardiogram was abnormal in 75 patients (66%), with an atrioventricular septal defect in 33, tetralogy of Fallot in 13, both of these anomalies in 2, a ventricular septal defect in 17, a patent ductus arteriosus beyond 7 days of age in 7, and other anomalies in 2. The sensitivity of physical examination findings for detection of cardiovascular anomalies was 80% and the specificity was 56%. The positive predictive value of an abnormal physical examination was 78% and the negative predictive value of a normal physical examination was 59%. Fifteen patients had a normal physical examination but an abnormal echocardiogram, nine of whom eventually required surgery. Physical examination alone is not sufficient to identify cardiovascular anomalies in neonates with Down syndrome. In the newborn with Down syndrome, the potential benefits of early diagnosis, in the context of physical examination findings, should be considered in determining whether an echocardiogram should be performed in the neonatal period.

Down Syndrome↗

PubMed2001

The rational clinical examination. Does this patient have a torn meniscus or ligament of the knee? Value of the physical examination.

CONTEXT: While most meniscal or ligamentous knee injuries heal with nonoperative treatments, a subset should be treated with arthroscopic or open surgery. OBJECTIVE: To analyze the accuracy of the clinical examination for meniscal or ligamentous knee injuries. DATA SOURCES: MEDLINE (1966-December 31, 2000) and HealthSTAR (1975-December 31, 2000) databases were searched for English-language articles describing the diagnostic accuracy of individual examination items for the knee and a combination of physical examination items (composite examination). Other data sources included reference lists from relevant articles. STUDY SELECTION: Studies selected for data extraction were those that compared the performance of the physical examination of the knee with a reference standard, such as arthroscopy, arthrotomy, or magnetic resonance imaging. Eighty-eight articles were identified, of which 23 (26%) met inclusion criteria. DATA EXTRACTION: A rheumatologist and an orthopedic surgeon independently reviewed each article using a standardized rating scale that scored the assembly of the study, the relevance of the patients enrolled, the appropriateness of the reference standard, and the blinding of the examiner. DATA SYNTHESIS: Summary likelihood ratios (LRs) were estimated from random effects models. The summary LRs for physical examination for tears of the anterior cruciate ligament, using the anterior drawer test, were 3.8 (95% confidence interval [CI], 0.7-22.0) for a positive examination and 0.30 (95% CI, 0.05-1.50) for a negative examination; the Lachman test, 25.0 (95% CI, 2.7-651.0) and 0.1 (95% CI, 0.0-0.4); and the composite assessment, 25.0 (95% CI, 2.1-306.0) and 0.04 (95% CI, 0.01-0.48), respectively. The LRs could not be generated for any specific examination maneuver for a posterior cruciate ligament tear, but the composite assessment had an LR of 21.0 (95% CI, 2.1-205.0) for a positive examination and 0.05 (95% CI, 0.01-0.50) for a negative examination. Determination of meniscal lesions, using McMurray test, had an LR of 1.3 (95% CI, 0.9-1.7) for a positive examination and 0.8 (95% CI, 0.6-1.1) for a negative examination; joint line tenderness, 0.9 (95% CI, 0.8-1.0) and 1.1 (95% CI, 1.0-1.3); and the composite assessment, 2.7 (95% CI, 1.4-5.1) and 0.4 (95% CI, 0.2-0.7), respectively. CONCLUSION: The composite examination for specific meniscal or ligamentous injuries of the knee performed much better than specific maneuvers, suggesting that synthesis of a group of examination maneuvers and historical items may be required for adequate diagnosis.

Anterior Cruciate Ligament Injuries↗

PubMed1988

Physical examination: a revered skill under scrutiny.

Clinicians in the 1980s rely on the physical examination to a lesser degree than their predecessors in making diagnostic and therapeutic decisions. The major criticisms are that the physical examination lacks sensitivity for many common diseases and has not been subjected to the same scientific scrutiny afforded laboratory testing. On the positive side, the physical examination is a series of diagnostic maneuvers that permit physicians to test hypotheses generated during history taking, to determine disease severity, and to lessen clinical uncertainty. Furthermore, the physical examination fosters the development of personalized medical care and a bond of mutual trust between patient and doctor. The challenge for tomorrow is to determine the operating characteristics of physical examination techniques and the clinical utility of physical findings. For preclinical students, emphasis should be directed at basic examination principles and sequencing. Many model programs have used patient instructors and other innovative techniques. Clinical students and postgraduate trainees need emphasis on interpretation of physical findings and their integration into the clinical context. There is no substitute for bedside teaching at this level.

Curriculum↗

PubMedDate not supplied

The prognostic value of the physical examination in patients with chronic heart failure.

The importance placed on the physical examination in the assessment of patients with cardiovascular disorders appears to be declining, perhaps in part due to a paucity of data showing its value in the modern era. To determine whether the physical examination provides important prognostic information in patients with chronic heart failure, the authors performed a post-hoc analysis of 2479 participants from the Studies of Left Ventricular Dysfunction (SOLVD) treatment trial. The presence of elevated jugular venous pressure and a third heart sound at baseline were each associated with subsequent heart failure hospitalization, the composite end point of death or heart failure hospitalization, and pump-failure death, independently of many other markers of disease severity. The subgroup of patients with at least one of these two physical examination findings was at increased risk for all-cause mortality. The authors believe that additional studies assessing the prognostic value of the physical examination should be conducted and, if favorable, likely would lead to a renewed interest in the physical examination.

Cardiac Output↗

PubMed2006

Attitudes toward the physical examination: a comparison of U.S. and Dominican medical students.

BACKGROUND: Little information exists regarding whether medical students learning in relatively resource-scarce countries develop greater confidence in their physical examination skills or whether, compared to U.S. medical students, they have more positive attitudes regarding the utility of the physical examination. PURPOSE: To compare U.S. And Dominican medical students' attitudes toward the physical examination. METHODS: We surveyed final-year students at 1 medical school in the United States and 1 in the Dominican Republic regarding self-confidence in and perceived utility of the physical examination. Using 5-point Likert-type scales with response choices ranging from 1 (not at all confident) to 5 (very confident) and 1 (not at all useful) to 5 (very useful), respondents reported their attitudes toward the physical examination overall and toward 14 specific physical examination skills. RESULTS: The survey response rate was 117/164 (71%). Students at the Dominican school, compared to students at the U.S. school, reported significantly greater confidence in their overall physical examination skill (mean response 4.27 vs. 3.79, respectively, p < .001) and more positive views about the utility of the physical examination overall for providing diagnostically useful information (mean response 4.78 vs. 4.42, respectively, p < .001). Results for the specific skills also showed more positive attitudes in the students from the Dominican medical school. CONCLUSIONS: Students at a Dominican medical school reported more positive attitudes toward the physical examination than students at a U.S. medical school.

Adult↗

PubMed1996

The relative diagnostic impact of screening mammography and physical examination.

OBJECTIVE: To determine the relative diagnostic impact of screening mammography and physical examination. METHODS: Data from the first 3.5 years of operation of the Ontario Breast Screening Program's regional facility in London were analyzed. A total of 14,646 women underwent screening, which involved both mammography and physical examination. The authors examined the relative contribution of the two types of examination according to detection rate, as well as size, stage and histologic type of the identified breast cancers. RESULTS: In total, 135 cancers were detected. Mammography revealed 131 (97.0%) of all cancers, whereas physical examination revealed only 66 (48.9%). Furthermore, the lesions detected by mammography were generally smaller and found at an earlier stage. CONCLUSION: Although most other screening programs involve mammography only, physical examination did make a contribution to the detection rate at the authors' facility. However, in an era of declining resources and cost containment, critical analysis of the value added by physical examination is necessary.

Aged↗

PubMedDate not supplied

Preseason physical examination for the prevention of sports injuries.

The importance of the preseason physical examination and preparticipation evaluation of sports candidates is highlighted because it constitutes one of the few occasions in which the physician can actively prevent sports injuries from occurring. As exercise participation continues to increase on a world-wide basis, an understanding of the goals and objectives of such a pre-exercise evaluation are important. The need is not for a standard evaluation form, but for a consistent understanding of adjusting the evaluation to the age of the candidate, the type of sport to be engaged in and the anticipated level of competition. Essentials of any evaluation are musculoskeletal, cardiovascular and psychological examinations. Examinations should have clearly defined objectives, and factors determining the type of evaluation include: prospective athlete; contemplated exercise programme; and motivation. Different types of implementation are individual examinations, locker room technique and the station technique, each with advantages and disadvantages. A pre-exercise evaluation should always occur before any anticipated change in level of school or competition with an interval or intercurrent history and physical examinations occurring at regular intervals. It is important that examinations take place before the commencement of a sports season so previous injuries and problems can be dealt with; timing is vital. Contents of a pre-exercise physical examination should include history, a physical examination, laboratory testing and additional specific screening evaluations. Finally, assessment of the pre-exercise evaluation and injury prediction will aid physicians in preparticipation evaluations.

Adolescent↗

PubMed2005

Effect of a physical examination teaching program on the behavior of medical residents.

CONTEXT: The reliance on physical examination as a diagnostic aid is in decline. OBJECTIVE: To determine whether an educational program can increase the use of physical examination by medical residents. DESIGN AND PARTICIPANTS: A series of educational workshops were provided to 47 second- and third-year medical residents at a large academic teaching hospital. MEASUREMENTS: Interns and students reported the frequency and depth of clinical examination performance on morning rounds by their residents before and up to six months after the workshops. Behavior before and after the workshops was compared using a mixed model. RESULTS: A total of 374 reports were returned (77% response). After adjusting for the type of service and observer, there was a statistically significant 23% increase (P=.02) in the performance of physical examination among residents who attended the course. Residents significantly increased the fraction of patients they examined on rounds (absolute increase 11%, P=.002) but did not increase the depth of their examination. The change was greatest on general medical teams, among whom the performance of physical examination had been least frequent. Teaching and feedback events on medicine teams by residents to their interns (2.8 and 1.1 events per 2 weeks, respectively) and medical students (5.9 and 2.8 events per 2 weeks, respectively) remained infrequent. CONCLUSIONS: A skills improvement program can significantly increase the frequency of physical examination, but teaching and feedback events remain sporadic and infrequent.

Adult↗

PubMed1999

The utility of physical examination in proximity penetrating extremity trauma.

This study assessed the efficacy of physical examination as a screening modality for the diagnosis of surgically significant arterial injury in proximity penetrating extremity trauma (PPET). All cases of PPET were assessed and admitted per established protocol over a 30-month period from January 1, 1993, to June 30, 1995. No patients were excluded if other body regions were also injured. Landmarks defining upper extremity injuries were the deltopectoral groove to the wrist and for lower extremities from the inguinal ligament to the ankle. Patients admitted with PPET fell into one of three categories: 1) no hard signs of vascular injury present-admitted for 24-hour observation; 2) presence of at least one hard sign of vascular injury-taken immediately to the operating room; 3) positive sign of arterial injury that requires angiography (i.e., diminished but appreciable pulse by physical examination or doppler, large nonexpanding hematoma, bilateral pulse deficit, no appreciable pulse with unreconstructable trajectory). Four hundred six patients with 489 injured extremities secondary to PPET were admitted over a 30-month period. Sixty-two extremities suffered multiple injuries. Of the extremities injured, 83 per cent were secondary to gunshot wounds, 12 per cent were attributed to stabs/lacerations, and 5 per cent were due to shotgun injuries. Four hundred twenty-one extremities with PPET fell into Group 1. There were four missed injuries (specificity, 99%) in this group (one ulnar artery, one radial artery, one posterior tibial artery, and one anterior tibial artery). Two of these injuries were considered surgically significant. None of the patients suffered limb or functional loss as a consequence of their missed arterial injury. Thirty-nine extremities were entered into Group 2, with two patients found to have no arterial injury. Twenty-nine extremities were placed into Group 3 with 10 (35%) found to have surgically significant injury on angiogram. The overall sensitivity and specificity for physical examination was 92 per cent and 95 per cent, respectively, for surgically significant injury. Physical examination is a highly sensitive and specific screening modality for the identification of surgically significant arterial injury in PPET. Patients who present with diminished, but appreciable, pulses by physical examination or doppler, large nonexpanding hematomas as the only sign, bilateral pulse deficits and nonappreciable pulses with unreconstructable trajectory benefit from further investigation with angiography.

Algorithms↗

PubMed1999

Evaluation of students' physical examination skills during their surgery clerkship.

BACKGROUND: Faculty often presume that students possess adequate physical examination skills upon graduation. Yet assessments of their performance with these skills often reveal deficiencies. This study was designed to determine if students' physical examination skills improved during their clerkship year. METHODS: Sixty-six students performed four specific physical examinations on patients during the first and last week of their surgery clerkship. Four consecutive clerkship rotations were examined. Encounters were videotaped and evaluated by faculty members. RESULTS: Posttest mean percent correct scores significantly improved for three examinations (P <0.01). Analysis of variance found no significant differences between clerkship mean percent correct scores. CONCLUSIONS: Students' physical examination skills improved slightly during their clerkship, however, no relationship was found between clerkship rotation and performance. These findings suggest unsupervised experiences during the third year do not positively influence student performance with physical examination skill proficiency.

Clinical Clerkship↗

PubMed1996

Value of the cardiovascular physical examination for detecting valvular heart disease in asymptomatic subjects.

To determine the accuracy of the cardiovascular physical examination for the diagnosis of asymptomatic valvular heart disease (VHD), we prospectively studied 143 subjects, 68 apparent normal subjects and 75 patients with diseases known to produce VHD. All subjects underwent a complete physical examination with dynamic cardiac auscultation by a physician blinded to clinical data and compared with the results of transesophageal color Doppler echocardiography (TEE). By TEE, 33 subjects (23%), and by physical examination, 25 subjects (17%) had at least 1 form of VHD. Despite a high frequency of mild valve abnormalities and a 31% prevalence of functional murmurs, the physical examination showed a sensitivity of 70%, a specificity of 98% (confidence interval = 0.51 to 0.84, and 0.94 to 0.99, respectively), and a positive and negative predictive value of 92% for the diagnosis of VHD. Only 2 of the 10 patients with VHD by TEE, but not by physical examination, had clinically important VHD. We conclude that the physical examination is a sensitive and highly specific method of screening for VHD in subjects without cardiac symptoms. Therefore, its use should be encouraged rather than the routine application of echocardiography.

Adult↗

PubMed2001

Prognostic values of physical examination findings in patients with chronic low back pain treated conservatively: a systematic literature review.

BACKGROUND: Most patients undergo physical examination. However, low back pain can only rarely be clearly diagnosed as having an irrefutable pathoanatomic cause on the basis of the classical battery of noninvasive physical examination procedures. However, physical examination findings are also used to predict the prognosis of treatment of chronic low back pain. A systematic review of the clinical literature is needed for an understanding of findings in this area. OBJECTIVES: To establish whether various physical examination procedures can be used to predict treatment outcome in the conservative (noninvasive) treatment of chronic low back pain. DATA SOURCES: From 910 titles published between 1986 and 1998, 10 original research reports were selected. These were obtained by means of a computerized MEDLINE search through use of various combinations of the key words low back pain, treatment, physical findings, predictors, prognosis, prognostic factors, prognostic indicators, and predictors and outcome(s); manual search strategies were also used. DATA SYNTHESIS: Articles that fitted the objectives of this review were retained and systematically reviewed for the prognostic value of the relevant tests/observations. In addition, results were studied in relation to type of outcome variable and type of treatment. RESULTS: The most commonly investigated tests were lumbar range-of-motion tests, which were found to have a clear-cut significant predictive value in 3 of 9 studies. Further analyses in relation to definition of outcome (back-to-work or reduction of symptoms) were not possible because study results were usually not clearly reported for each definition and because therapies were multimodal rather than distinctly well defined. CONCLUSIONS: This area has not been fully investigated. Therefore, there is no satisfactory answer to the question of whether some physical examination tests have a prognostic value in the conservative treatment of chronic low back pain.

Chronic Disease↗

PubMed1979

Physical examination of the lumbosacral complex.

Examination is the foundation upon which effective treatment rests. The importance of a methodical step-by-step process is stressed. The manner in which the examination findings are used to assess the efficacy of the treatment techniques is illustrated. This paper outlines one method of examining the lumbosacral complex.

Back Pain↗