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...
| Autores principales: | , , , , |
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| Formato: | Artículo revista |
| Lenguaje: | Español |
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Universidad Nacional Córdoba. 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: |
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I10-R327-article-25996 |
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| record_format |
ojs |
| institution |
Universidad Nacional de Córdoba |
| institution_str |
I-10 |
| repository_str |
R-327 |
| container_title_str |
Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Español |
| format |
Artículo revista |
| topic |
vesicular murmur auscultation chest radiography murmullo vesicular auscultación Rx de tórax |
| spellingShingle |
vesicular murmur auscultation chest radiography murmullo vesicular auscultación Rx de tórax Wieshamm, M Kitzmann, P Resnichenco, M Alvarez , M Rojo, S Accuracy of Vesicular Murmur by auscultation, compared to chest radiography in respiratory disease. |
| topic_facet |
vesicular murmur auscultation chest radiography murmullo vesicular auscultación Rx de tórax |
| author |
Wieshamm, M Kitzmann, P Resnichenco, M Alvarez , M Rojo, S |
| author_facet |
Wieshamm, M Kitzmann, P Resnichenco, M Alvarez , M Rojo, S |
| author_sort |
Wieshamm, M |
| title |
Accuracy of Vesicular Murmur by auscultation, compared to chest radiography in respiratory disease. |
| title_short |
Accuracy of Vesicular Murmur by auscultation, compared to chest radiography in respiratory disease. |
| title_full |
Accuracy of Vesicular Murmur by auscultation, compared to chest radiography in respiratory disease. |
| title_fullStr |
Accuracy of Vesicular Murmur by auscultation, compared to chest radiography in respiratory disease. |
| title_full_unstemmed |
Accuracy of Vesicular Murmur by auscultation, compared to chest radiography in respiratory disease. |
| title_sort |
accuracy of vesicular murmur by auscultation, compared to chest radiography in respiratory disease. |
| description |
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%. |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2019 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/25996 |
| work_keys_str_mv |
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2024-09-03T21:01:18Z |
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2024-09-03T21:01:18Z |
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I10-R327-article-259962024-08-27T18:26:40Z Accuracy of Vesicular Murmur by auscultation, compared to chest radiography in respiratory disease. Exactitud del Murmullo Vesicular (por auscultación) comparada con Radiografía de Tórax (patrón de referencia) en patología respiratoria Wieshamm, M Kitzmann, P Resnichenco, M Alvarez , M Rojo, S vesicular murmur auscultation chest radiography murmullo vesicular auscultación Rx de tórax 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%. Cambios ocurridos en el diagnóstico médico, no han sido acompañados en igual medida por revisión de maniobras semiológicas aceptadas empíricamente sin una validación. Nuestra hipótesis plantea que en el examen del aparato respiratorio, la auscultación del murmullo vesicular (MV) como primera maniobra semiológica (MS) puede identificar pacientes que van a necesitar ulterior investigación, haciendo mas racional la exploración. El objetivo del trabajo fue determinar la exactitud diagnóstica del MV por auscultación comparado con la radiografía de tórax (RxT) en patologías del aparato respiratorio. En el Servicio de Neumología del H.N.C. (Córdoba), entre Marzo 2018 - Febrero 2019, 153 pacientes consecutivos derivados por problemas respiratorios, luego de una anamnesis sobre síntomas, identificación de signos y factores de riesgo, fueron auscultados con estetoscopio Littmann. Se documentaron los hallazgos en forma dicotómica (MV presente, normal o MV ausente o disminuído, anormal). Luego se solicito Rx. Tórax (RxT). Se respetaron las premisas básicas para evitar sesgos; luego se determino sensibilidad (S), especificidad (E), (VPP) y (VPN), tasas de prob. (LR+) y (LR -) y coc. DOR (Diagnostic Odds Ratio). En los 91 pac. con MV anormal, 75 tuvieron Rx.T Anormal (V +) con alteraciones consistentes en Atr. aéreo , derrame pleural, condensación, Infiltrados y diafr. elevado y 16 con Rx. T Normal (F +), 62 pacientes con MV Normal presentaron Rx. T Normal 60 pacientes ( V -) y Anormal solo 2 pacientes (F -). Los resultados estadísticos mostraron que el MV tiene una S del 97% y una E del 75% para detectar enfermedad en el aparato respiratorio para una prevalencia de patologías respiratorias del 50%, con un VP + del 82% y VP- del 97% ; LR+ de 4,63 y LR- del 0,03 y un coc. DOR de 154. Ante una prevalencia de patología respiratoria alta por ser en 3º nivel (50%), el MV demuestra buen desempeño para seleccionar pacientes que necesitarán ulterior evaluación. Con una S del 97% puede excluir patología respiratoria (Tasa de FN del 3%) cumple con el acrónimo SENEX (SE alta resultado Neg. EXcluye), si contrastamos los resultados con una prevalencia menor como APS, estimada en 15% , un MV anormal la aumenta a 45% y un MV normal la reduce a 1%. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2019-10-28 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://revistas.unc.edu.ar/index.php/med/article/view/25996 Revista de la Facultad de Ciencias Médicas de Córdoba.; 2019: Suplemento JIC XX Revista de la Facultad de Ciencias Médicas de Córdoba; 2019: Suplemento JIC XX Revista da Faculdade de Ciências Médicas de Córdoba; 2019: Suplemento JIC XX 1853-0605 0014-6722 10.31053/1853.0605.v76.nSuplemento spa https://revistas.unc.edu.ar/index.php/med/article/view/25996/27865 Derechos de autor 2019 Universidad Nacional de Córdoba https://creativecommons.org/licenses/by-nc/4.0 |