Accuracy of Vesicular Murmur by auscultation, compared to chest radiography in respiratory disease.
Changes in medical diagnosis has not been followed at the same pace by a review of the empirically accepted semiological maneuvers, without validation. We hypothesize that when examining the respiratory system, the vesicular murmur auscultation (VM) as a first semiological maneuver can identify pati...
Guardado en:
| Autores principales: | , , , , |
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| Formato: | Artículo revista |
| Lenguaje: | Español |
| Publicado: |
Universidad Nacional Cba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2019
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| Materias: | |
| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/25996 |
| Aporte de: |
| Sumario: | Changes in medical diagnosis has not been followed at the same pace by a review of the empirically accepted semiological maneuvers, without validation. We hypothesize that when examining the respiratory system, the vesicular murmur auscultation (VM) as a first semiological maneuver can identify patients who will need further work up, aiming to a more rational investigation.
The objective of this investigation was to determine the diagnostic accuracy of VM by auscultation, compared to chest radiography (CR) in respiratory disease.
Between March 2018 and February 2019, 153 consecutive patients referred to the “Hospital Nacional de Clinicas (Cordoba)” Pulmonology Service were auscultated with a Littmann stethoscope, after anamnesis on respiratory symptoms with identification of signs and risk factors. Findings were dichotomously documented (VM present: normal, or VM absent or diminished: abnormal) and a CR was obtained. Any findings consistent with air entrapment, pleural effusion, condensations, infiltrates and/or elevated diaphragms in the CR were considered as “abnormal CR”. Sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), likelihood ratios (LR+ and LR-) and diagnostic odds ratios (DOR) were calculated.
In 91 patients with abnormal VM, 75 had an abnormal CR (true positives) and 16 had a normal CR (false positives). Of 62 patients with normal VM on auscultation, 60 had a normal CR (true negatives) and 2 patients had an abnormal CR (false negatives). Statistical analysis showed that the VM auscultation had a 97% sensitivity and 75% specificity to detect respiratory tract disease, with an 82% PPV and 97% NPV; LR+ of 4.63, LR- of 0.03 and a DOR of 154.
In our Institution, a 3rd level center of reference with a high prevalence of respiratory disease and pathology (about 50%), the VM auscultation showed good performance to select patients for further work up. It could exclude respiratory disease with a 97% sensitivity and a 3% false negative rate. When these results are compared to a lower prevalence setting, such as Primary Care level, with estimates of 15% prevalence for respiratory pathology, abnormal RS increases the likelihood to 45%, whereas normal VM reduces it to 1%. |
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