Which physical exam findings are most useful in evaluating a suspected pleural effusion?

Bottom line:  Dullness to percussion and asymmetric chest expansion are most accurate physical exam findings for diagnosing pleural effusion.

SummaryDoes this patient have a pleural effusion? Rational Clinical Exam in JAMAevidence.

From a systematic review of studies evaluating diagnostic accuracy of the physical exam in pleural effusion.  Table 71-4 summarizes sensitivities/specificities and positive/negative likelihood ratios for physical exam findings.  Only one study evaluated all the common physical exam findings.  Dullness to percussion and asymmetric chest expansion had the greatest positive LR (>8 in each case.)  Each of these findings also had negative LR < 0.30.

jkn 2/16

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About Amy

Clinical Informationist at EUH Branch Library
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