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How Accurate Is Physical Exam in Detecting Abdominal Aortic Aneurysm?

The prevention of morbidity and mortality from abdominal aortic aneurysm (AAA) requires early detection, but the accuracy of physical examination is unknown. Researchers from the Minneapolis Veterans Affairs Medical Center asked 99 patients with known AAA (diameter, 3.0 to 6.9 cm) and 101 control patients to undergo separate abdominal examinations by 2 internists who were blinded to each other's exams and to ultrasound results. The mean age of the patients was 73 years.

Overall, physical examination had a sensitivity of 68 percent and specificity of 75 percent for AAA detection, but sensitivity was higher (82 percent) for AAAs of 5 cm or larger. Sensitivity for AAAs of any size was 91 percent in patients with abdominal girths of less than 100 cm, compared with 53 percent in those with girths of 100 cm or greater, a significant difference. In patients with girths of less than 100 cm, sensitivity for AAAs of 5 cm or larger was 100 percent.

Comment: Physical examination was a relatively effectively screening tool for AAA in this study, but examiners were not blinded to the study's purpose. In addition, there was a high prevalence of AAA in the study population, favorably affecting the predictive value of physical exam. Nonetheless, these results tentatively suggest a useful role for the physical exam in AAA detection, especially in lean patients.

— TL Schwenk

Published in Journal Watch General Medicine April 4, 2000

Citation(s):

Fink HA et al. The accuracy of physical examination to detect abdominal aortic aneurysm. Arch Intern Med 2000 Mar 27 160 833-836.

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