Reproduction of chest pain by palpation: diagnostic accuracy in suspec
http://www.100md.com
《英国医生杂志》
1 Equipe d'accueil 3878 (GETBO), Brest University Hospital, 29609 Brest, France, 2 Division of General Internal Medicine, Department of Internal Medicine, Geneva Faculty of Medicine, Geneva University Hospital, CH-1211 Geneva, Switzerland.
Correspondence to: G Le Gal gregoire.legal@chu-brest.fr
Introduction
In patients with suspected pulmonary embolism, chest pain reproduced by palpation is not associated with a lower prevalence of pulmonary embolism. Limitations of our findings are the absence of a standardised definition and evaluation method for eliciting chest pain by palpation. Moreover, these results may not apply to all patients with chest pain, as many patients in the emergency department may have been classified as having another obvious aetiology and were not included in the study.
Elicitation of chest pain is widely used by doctors to assess the clinical likelihood of pulmonary embolism. However, in patients without an obvious aetiology, pain in the chest that is reproduced by palpation is not associated with a lower prevalence of pulmonary embolism. Physicians should take into account that the usefulness of these widespread semiologic descriptions may be limited in this situation.
What is already known on this topic
Chest pain that is reproduced by palpation is classically thought to be caused by pathology of the musculoskeletal chest wall and may prompt clinicians to discard pulmonary embolism as the cause of pain
The diagnostic accuracy of this clinical criterion is unknown
What this study adds
In patients in whom pulmonary embolism is suspected, chest pain that is reproduced by palpation is not associated with a lower prevalence of pulmonary embolism
This article was posted on bmj.com on 31 January 2005: http://bmj.com/cgi/doi/10.1136/bmj.38331.602384.8F
Contributors: All authors had access to the data, read, and approved the final version of the manuscript. GL and AP are guarantors.
Competing interests: None declared.
References
Stein PD, Henry JW. Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes. Chest 1997;112: 974-9.
Dreyfuss AI, Weiland DS. Chest wall tenderness as a pitfall in the diagnosis of pulmonary embolism. A report of two cases. Arch Intern Med 1984;144: 2057.
Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 2000;342: 1163-70.
Perrier A, Roy PM, Aujesky D, Chagnon I, Howarth N, Gourdier L, et al. Diagnosing pulmonary embolism with clinical assessment, D-dimer, venous ultrasound and helical computed tomography: a multicenter management study. Am J Med 2004;116: 291-9.
Wicki J, Perneger TV, Junod AF, Bounameaux H, Perrier A. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med 2001;161: 92-7.(Grégoire Le Gal, physician1, Ariane Test)
Correspondence to: G Le Gal gregoire.legal@chu-brest.fr
Introduction
In patients with suspected pulmonary embolism, chest pain reproduced by palpation is not associated with a lower prevalence of pulmonary embolism. Limitations of our findings are the absence of a standardised definition and evaluation method for eliciting chest pain by palpation. Moreover, these results may not apply to all patients with chest pain, as many patients in the emergency department may have been classified as having another obvious aetiology and were not included in the study.
Elicitation of chest pain is widely used by doctors to assess the clinical likelihood of pulmonary embolism. However, in patients without an obvious aetiology, pain in the chest that is reproduced by palpation is not associated with a lower prevalence of pulmonary embolism. Physicians should take into account that the usefulness of these widespread semiologic descriptions may be limited in this situation.
What is already known on this topic
Chest pain that is reproduced by palpation is classically thought to be caused by pathology of the musculoskeletal chest wall and may prompt clinicians to discard pulmonary embolism as the cause of pain
The diagnostic accuracy of this clinical criterion is unknown
What this study adds
In patients in whom pulmonary embolism is suspected, chest pain that is reproduced by palpation is not associated with a lower prevalence of pulmonary embolism
This article was posted on bmj.com on 31 January 2005: http://bmj.com/cgi/doi/10.1136/bmj.38331.602384.8F
Contributors: All authors had access to the data, read, and approved the final version of the manuscript. GL and AP are guarantors.
Competing interests: None declared.
References
Stein PD, Henry JW. Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes. Chest 1997;112: 974-9.
Dreyfuss AI, Weiland DS. Chest wall tenderness as a pitfall in the diagnosis of pulmonary embolism. A report of two cases. Arch Intern Med 1984;144: 2057.
Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 2000;342: 1163-70.
Perrier A, Roy PM, Aujesky D, Chagnon I, Howarth N, Gourdier L, et al. Diagnosing pulmonary embolism with clinical assessment, D-dimer, venous ultrasound and helical computed tomography: a multicenter management study. Am J Med 2004;116: 291-9.
Wicki J, Perneger TV, Junod AF, Bounameaux H, Perrier A. Assessing clinical probability of pulmonary embolism in the emergency ward: a simple score. Arch Intern Med 2001;161: 92-7.(Grégoire Le Gal, physician1, Ariane Test)