Positive-predictive value of clinical suspicion of abdominal aortic aneurysm

Abstract

To the Editor .—Beede and colleagues 1 state that their data on the positive— predictive value of the of abdominal aortic aneurysms (AAAs) indicate that screening for AAAs in routine practice based on of AAAs may be much less cost-effective than proposed by us 2 and by others. 3 This statement can be challenged on several grounds. First, because of the retrospective nature of the study, there could be no specific criteria for a clinical assessment of AAA. The authors note that normal aortic pulsation in thin persons was probably a frequent reason for ultrasound. In contrast, our study 2 confirmed the dictum of Osler 4 that only an enlarged aortic pulsation should be considered evidence of AAA. The positive-predictive value of an ill-defined should not be compared with the positive-predictive value that we reported for a pulsatile mass. Referral based on