Patient Physical Examination Research Articles

AB0422 Orofacial evaluation in women with rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) can affect any synovial joint. Unlike the hand, ever so valued in the physical examination of patients with RA, the joints in the area of the jaw...

Groin Pain in Young Male Adults: Retrospective Evaluation of 446 Patients

Aim: In young male adults; groin pain is evaluated as an inguinal hernia and usually referred to general surgeons. Less frequently; urological, internal and orthopedical diseases can cause to groin pain. Material and Methods: The side of groin pain (right, left or bilateral), whether or not surgery, physical examination, and ultrasonographic (USG) results were analysed from the soldier patients who applied to department of General Surgery of Agri Military Hospital with groin pain complaint from 01 January 2011 to 31 December 2011. Results: 446 (14%) of the 3196 patients were applied with groin pain complaint with 58,3% right, 39,6% left, and 2,1% bilateral groin pain. Inguinal hernia was detected 43,8% at right, 28,1% at left, and 0,6% at bilateral with physical examination in patients with groin pain. At right 28,5% normal, 5,7% inguinal lymphadenomegaly, and 3,2% urological pathology was found in the evaluation of USG results. At left 13,1% normal, 8,1% inguinal lymphadenomegaly, and 11,4% urological pathology was found. No pathology was found with USG in bilateral groin pain. Conclusion: Urological, orthopedical pathology, and lymphadenopathy should be considered in the differential diagnosis of groin pain except inguinal hernia in young male adults. USG is a non-invasive, easy, cheap method with high degree of accuracy properties and should be first alternative imaging at the differential diagnosis of undetermined inguinal hernia on physical examination in the patients with groin pain.

Ovarian Steroid Cell Tumor: Report Of Four Cases

SUMMARY Steroid cell tumors are tumors that account for less than 0.1% of all ovarian malignant tumors and cause increase in secretion of androgen or estrogen. Steroid cell tumors usually occur in the post-menopausal period. This article reports four steroid cell tumor cases who underwent surgery for overian mass during post-menopausal period, who were diagnosed with steroid cell tumor after histopathological examination and displayed different clinical manifestations. No signs of increased hormonal activity in two of these cases were On the other hand, the other two cases applied with complaints of menopausal vaginal bleeding, which led to the consideration of increased estrogenic activity in these two cases. Case 1 The case, who was 77 years of age in her postmenopausal period, applied to our hospital with the complaint of urinary incontinence. The routine laboratory findings of the patient, who had no feature in her history, were within normal limits. No findings of virilization were observed during the physical examination of the patient. During the gynaecological examination, a mass of approximately 6 cm was detected in the right adnexal area. The transvaginal ultrasonography (TVUSG) revealed an endometrial thickness of 9 mm, and an approximately 72mm-sized solid-cystic mass, surrounded with free liquid in the right ovary area. The preoperative Case 2 In the TVUSG performed during the routine follow- up examinations at the menopause clinic of the 52 year-old case, who did not have active complaints, a 66 X 35 mm mass with the possibility of dermoid cyst was detected in the right ovary. There was no feature in the patient's physical examination, her history and family history. The gynaecological examination, during which an approximately 6 cm mass was palpated in the right adnexial area, revealed a CA 125 value of 9.07 IU/ml. With the preliminary diagnosis of pelvic mass, laparoscopic right salpingo-ooforectomy was performed. The intraoperative pathological examination reported was not observed. The paraffin block indicated a right ovarian steroid cell tumor; the largest diameter of the capsule was 8 cm and the capsule had a ruptured appearance; there was 1 mitosis /10 HPF, focal light atypia and focal hemorrhage but there was no presence of necrosis. Based on these findings, it was decided that the potential for malignancy was low. Adjuvant treatment during the postoperative period was not considered. The patient did not come to the follow-up examinations after the operation. Figure 2: The postoperative paraffin block section of case 1. Case 3 The 64-year-old case who was in her postmenopausal period applied to our hospital with vaginal bleeding complaints. The routine laboratory findings of the patient, who had no feature in her history and family history, were within normal limits. In the physical examination of the case, virilization and increased hormonal activity findings were not It was thought that postmenopausal vaginal bleeding could be associated with hyperestrogenic environment. A 10 cm-diameter mobile mass, the borders of which could not be clearly differentiated from the uterus and right ovary and filled up the Douglas space, was detected during the gynaecological examination. The TVUSG

Feasibility and clinical implementation of hand-held echocardiography

Echocardiography is essential in the evaluation of patients with suspected or known cardiovascular disease. The development of pocket-size hand-held echocardiographic devices, suitable for a quick assessment of cardiac structures and function, has been shown to improve diagnostics and patient workflow. In the hands of experts, pocket-size machines capable of gray tone and color flow imaging offer high accuracy for the assessment of ventricular function, the detection of pericardial and pleural effusions and are suitable for semiquantitative evaluation of valvular function. The machines are also suitable for noncardiac imaging. Point-of-care echocardiography with pocket-size hand-held echocardiographic devices should be an integrated part of the physical examination of patients in many situations and will probably be performed by an increasing number of both experts and nonexperts as well. However, the benefit relies on the level of competence of the users and tailored training is needed to answer specific questions.

An analysis of deep vein thrombosis in 1277 consecutive neurosurgical patients undergoing routine weekly ultrasonography

Patients requiring neurosurgical intervention are known to be at increased risk for deep vein thrombosis (DVT) and attendant morbidity and mortality. Pulmonary embolism (PE) is the most catastrophic sequela of DVT and is the direct cause of death in 16% of all in-hospital mortalities. Protocols for DVT screening and early detection, as well as treatment paradigms to prevent PE in the acute postoperative period, are needed in neurosurgery. The authors analyzed the effectiveness of weekly lower-extremity venous duplex ultrasonography (LEVDU) in patients requiring surgical intervention for cranial or spinal pathology for detection of DVT and prevention of PE. Data obtained in 1277 consecutive patients admitted to a major tertiary care center requiring neurosurgical intervention were retrospectively reviewed. All patients underwent admission (within 1 week of neurosurgical intervention) LEVDU as well as weekly LEVDU surveillance if the initial study was normal. Additional LEVDU was ordered in any patient in whom DVT was suspected on daily clinical physical examination or in patients in whom chest CT angiography confirmed a pulmonary embolus. An electronic database was created and statistical analyses performed. The overall incidence of acute DVT was 2.8% (36 patients). Of these cases of DVT, a statistically significant greater number (86%) were discovered on admission (within 1-7 days after admission) screening LEVDU (p < 0.05), whereas fewer were documented 8-14 days after admission (2.8%) or after 14 days (11.2%) postadmission. Additionally, for acute DVT detection in the present population, there were no underlying statistically significant risk factors regarding baseline physical examination, age, ambulatory status, or type of surgery. The overall incidence of acute symptomatic PE was 0.3% and the mortality rate was 0%. Performed within 1 week of admission in patients who will undergo neurosurgical intervention, LEVDU is effective in screening for acute DVT and initiating treatment to prevent PE, thereby decreasing the overall mortality rate. Routine LEVDU beyond this time point may not be needed to detect DVT and prevent PE unless a change in the patient's physical examination status is detected.

Barriers to undergraduate peer-physical examination of the lower limb in the health sciences and strategies to improve inclusion: a review

Peer-physical examination is a widely adopted and an integral component of the undergraduate curriculum for many health science programs. Unwillingness or perceived inability to participate in peer-physical examination classes may have a negative impact upon students' abilities to competently conduct physical examinations of patients in future as registered health professionals. A literature review on the perceptions and attitudes of peer-physical examination of the lower limb amongst medical and health science students was conducted to identify potential barriers to participation, and to review strategies to improve participation in classes designed to develop clinical examination skills. A pragmatic search strategy of the literature from PubMed and Google Scholar published prior to June 2012 yielded 23 relevant articles. All articles were concerned with the views of medical students' education and there were no articles explicitly addressing the role of peer-physical examination in health science disciplines. Several ethical issues were identified including feelings of coercion, embarrassment, and perceptions of a lack of consideration for cultural and religious beliefs. The available evidence suggests that barriers to participation may be overcome by implementing standard protocols concerned with obtaining informed written consent, adequate choice of peer-examiner, changing facilities and garment advice, and possible alternative learning methods.

Symptoms and Signs of Neuro-otologic Disorders

Symptoms and signs of neuro-otologic disorders are critical components in the diagnostic assessment of patients with vestibular symptoms such as vertigo, dizziness, unsteadiness, and oscillopsia. Most diagnoses can be accomplished at the bedside. An understanding of key diagnostic principles is essential for all practicing neurologists, who are often faced with determining whether such patients warrant urgent diagnostic testing or hospital admission. This article introduces readers to core concepts and recent advances in the understanding of directed history taking and physical examination in patients with vestibular symptoms or suspected neuro-otologic disorders. International consensus definitions for vestibular symptoms have recently been published. During the past 5 years, a growing body of scientific evidence has demonstrated that the traditional approach to bedside diagnosis of patients with vertigo and dizziness is inadequate. Former teaching that history taking should first rely on categorizing symptoms by type (eg, vertigo, presyncope, disequilibrium, nonspecific dizziness) has been replaced by an emphasis on categorizing timing and triggers for vestibular symptoms, which focuses the clinician's attention on four key syndromic patterns: (1) acute, spontaneous, prolonged vestibular symptoms; (2) episodic, positional vestibular symptoms; (3) episodic, spontaneous vestibular symptoms; and (4) chronic unsteadiness (with or without oscillopsia). Each of these categories delineates a relatively narrow differential diagnosis within which a focused examination distinguishes between benign common causes and dangerous uncommon ones. A focused approach to bedside assessment of patients with vestibular symptoms is essential for accurate and efficient diagnosis. All neurologists should be aware of major recent advances.

Non-Infectious Cause of an Acute Lower Gastrointestinal Bleeding in an HIV-Infected Male Patient

Purpose: Amyloidosis is an unusual disease which clinicians may not consider when confronted with a patient complaining of lower gastrointestinal (GI) bleeding. Methods: Primary amyloidosis is more common than secondary amyloidosis but GI involvement is less common in primary amyloidosis. Patients with Primary GI amyloidosis have polypoid protrusions and thickening of the valvulae conniventes on colonoscopy whereas patients with secondary GI amyloidosis have mucosal friability and erosions. Results: A 57-year-old African American male with PMH of AIDS presented with the chief complaint of hematochezia for the past three days. Review of systems was significant for intermittent headaches, dyspnea on exertion and generalized weakness. Patient's current medications include lamivudine, zidovudine, indinavir, ritonavir and low dose aspirin. Patient had 15 pack year smoking history and intravenous drug abuse with heroin and cocaine. Patient's physical examination was significant for mild conjuctival pallor. Labs reveal normocytic anemia. Colonoscopy showed multiple erosions and ulcers in the terminal ileum as well as continuous inflammation of colonic mucosa (Figure 1) from the rectum to approximately 30 cm from anal verge with abrupt transition to normal mucosa and multiple biopsies were taken from these areas. Histology revealed marked amyloid deposits (Figure 2) in the vessel walls. Patient was referred for hematology evaluation but unfortunately he failed to follow-up.Figure: No Caption available.Figure: [1187]Conclusion: This case serves to heighten awareness to the possible diagnosis of GI amyloidosis in patients presenting with lower GI bleeding.

Exploration of the attitudes of nursing students to peer physical examination and physical examination of patients

The use of peer physical examination (PPE) in early clinical skills has been studied amongst medical students. The majority of students are comfortable with using peer physical examination, when sensitive areas are excluded. Students' attitudes are related to their personal characteristics: gender, age, religious faith, and ethnicity. There is no data on nursing students' attitudes to peer physical examination. Identify and explore: Dual cohort, cross-sectional, anonymous survey. Three-year undergraduate nursing programme, skills centre and service clinical learning. All first and third year nursing students were asked to complete a modified Examining Fellow Students questionnaire at the end of 2008. The questionnaire asked students to indicate which of 12 body areas they would not be willing to examine/have examined by a peer of the same/opposite gender. This study also asked students which of the 12 body areas they felt uncomfortable examining on patients. The response rate was 76% (128/168). The students were predominantly female (93% female; 7% male). Most students were comfortable with examining non-sensitive body regions of peers (78.2%-100% willing) and patients (92.3-100% willing). Male gender was significantly associated with willingness to examine and be examined by peers (p=0.001); Asian students were significantly less willing to engage in peer physical examination with opposite gender (p<0.007). Year 3 students were significantly more comfortable than Year 1 in examining patients of either gender (p<0.001). In spite of the male gender findings, this predominantly female population expresses similar attitudes to the gender-balanced medical student studies - high acceptability for non-sensitive areas. The role of characteristics and attitudes to peer physical examination shows similarities and differences to other studies. Student characteristics were not related to patient examination attitudes.

A Selective Memory Deficit Caused by Autoimmune Encephalopathy Associated With Hashimoto Thyroiditis

We report a longstanding selective memory deficit in a euthyroid 45-year-old woman who was being treated with levothyroxine for Hashimoto thyroiditis. The patient had complained of memory problems and deterioration of her concentration skills for about 2 years. Her endocrinologist thought that she was depressed. The patient's physical examination was normal. She scored a full 30 points on the Mini-Mental State Examination, but neuropsychological evaluation showed a significant deficit in her verbal memory. Routine blood tests and cerebrospinal fluid analysis showed only antithyroid peroxidase antibodies. Brain magnetic resonance imaging was normal. Electroencephalogram showed scarce intermittent bilateral multifocal theta waves. We increased the patient's daily dose of levothyroxine and started her on dexamethasone therapy. Five months later, we repeated the entire evaluation and found both her cognitive function and her electroencephalogram to be normal. Autoimmune encephalopathy associated with Hashimoto thyroiditis is already known to present with either stroke-like episodes or diffuse progressive deterioration. Our patient shows that the encephalopathy can present as a chronic selective memory deficit that can spare executive functions and short-term memory. This presentation can be missed or mistaken for depression, but can be diagnosed with a detailed neuropsychological evaluation.

Olanzapine and Benztropine as a Cause of Ischemic Colitis in a 27-year-old Man

Ischemic colitis is a rare adverse effect of antipsychotic medications and is most commonly associated with the phenothiazine class of antipsychotics and atypical antipsychotics such as clozapine and olanzapine. The risk is further increased when antipsychotics are taken in conjunction with anticholinergics. A 27-year-old man with a history of bipolar disorder and depression presented to the emergency department with 6 days of constipation, abdominal pain, nausea, and nonbloody vomiting. He later developed multiple episodes of hematochezia and fever. Within the preceding 2 weeks, his medication regimen of divalproex sodium, aripiprazole, and trihexyphenidyl, had been changed to olanzapine, benztropine, and bupropion. The patient's physical examination showed diffuse abdominal tenderness, guarding, and distension and laboratory tests revealed a leukocytosis. A computed tomographic scan of the abdomen/pelvis showed colitis extending from the splenic flexure to the sigmoid colon, without evidence of perforation. A colonoscopy revealed severe ischemic colitis involving the descending and sigmoid colon, which was confirmed on biopsy. Given the temporal association between the new medications and onset of symptoms, the patient's ischemic colitis was likely caused by olanzapine or the combination of olanzapine and benztropine, likely secondary to their anticholinergic properties. Thus, providers should take a thorough history and counsel patients regarding the risks of constipation when starting antipsychotic medications, particularly those with anticholinergic activity. Despite the fact that ischemic colitis is such a rare adverse effect of antipsychotic medications, it is important to consider because of its potentially fatal outcomes.

Should Rheumatologists Palpate the Breast?: Table 1.

To the Editor: Few would deny that the physical examination of patients is devalued today. There are several reasons for this. Crowded waiting rooms exert an abortive pressure on this time-honored art. Also, validated, simplified but “equally effective” instruments used in drug trials concentrate the rheumatologist’s attention on the joint homunculus at the neglect of almost everything else. Lastly, widespread access to ultrasonography and magnetic resonance imaging has shifted the emphasis from … Address correspondence to Dr. Canoso, American British Cowdray Medical Center, Sur 136, No. 116, Mexico D.F. 01120, Mexico. E-mail: jcanoso{at}gmail.com

Diagnosis of Primary Task-Specific Lower Extremity Dystonia in a Runner

Resident's case problem. A 56-year-old man was referred to physical therapy for analysis of unusual gait, first noticed 3 years previously when running. Prior to this evaluation, the patient had seen multiple orthopaedic, sports medicine, and neurological specialists while undergoing repeated and extensive testing. Ten months of testing and treatment, including conservative and surgical management, did not provide an explanation for the gait abnormality or result in improvement of the patient's condition. The patient's physical examination was relatively unremarkable, considering the severity of the gait abnormality. Distinct abnormalities were apparent with computerized gait analysis and dynamic electromyography, and, when combined with the physical examination findings, led to a suspicion of the task-specific disorder of runner's dystonia. The patient was referred to a neurologist specializing in movement-related disorders, with a final confirmed diagnosis of primary task-specific dystonia with first onset during running (ie, runner's dystonia). Idiopathic, task-specific dystonia of the lower extremity is documented as a very rare occurrence, yet increasing trends in running participation may result in a higher incidence of this condition. Improved awareness of runner's dystonia in the present case might have enhanced the clinical decision-making process and resulted in more timely and effective treatment solutions. Clinical examination findings, including computerized gait analysis and electromyography, in conjunction with imaging, blood, and genetic testing, can aid in the diagnosis of runner's dystonia. Differential diagnosis, level 4.

Biomechanical factors and physical examination findings in osteoarthritis of the knee: associations with tissue abnormalities assessed by conventional radiography and high-resolution 3.0 Tesla magnetic resonance imaging

IntroductionWe aimed to explore the associations between knee osteoarthritis (OA)-related tissue abnormalities assessed by conventional radiography (CR) and by high-resolution 3.0 Tesla magnetic resonance imaging (MRI), as well as biomechanical factors and findings from physical examination in patients with knee OA.MethodsThis was an explorative cross-sectional study of 105 patients with knee OA. Index knees were imaged using CR and MRI. Multiple features from CR and MRI (cartilage, osteophytes, bone marrow lesions, effusion and synovitis) were related to biomechanical factors (quadriceps and hamstrings muscle strength, proprioceptive accuracy and varus-valgus laxity) and physical examination findings (bony tenderness, crepitus, bony enlargement and palpable warmth), using multivariable regression analyses.ResultsQuadriceps weakness was associated with cartilage integrity, effusion, synovitis (all detected by MRI) and CR-detected joint space narrowing. Knee joint laxity was associated with MRI-detected cartilage integrity, CR-detected joint space narrowing and osteophyte formation. Multiple tissue abnormalities including cartilage integrity, osteophytes and effusion, but only those detected by MRI, were found to be associated with physical examination findings such as crepitus.ConclusionWe observed clinically relevant findings, including a significant association between quadriceps weakness and both effusion and synovitis, detected by MRI. Inflammation was detected in over one-third of the participants, emphasizing the inflammatory component of OA and a possible important role for anti-inflammatory therapies in knee OA. In general, OA-related tissue abnormalities of the knee, even those detected by MRI, were found to be discordant with biomechanical and physical examination features.

Exercise-Induced Intranodal Atrioventricular Block

Exercise-induced atrioventricular (AV) block in patients with normal AV conduction at rest is rare. Herein, we describe the case of a 67-year-old woman with normal 1 : 1 AV conduction at rest, who developed complete AV block during a treadmill test. Our patient complained of effort-related dizziness and dyspnea, which had been ongoing for 3 months. The patient's physical examination was normal. The resting electrocardiogram showed left anterior fascicular block with a PR interval of 0.19 seconds. The echocardiogram was normal except for mild aortic valve regurgitation. During the treadmill test, the patient developed complete AV block at a sinus rate of 90 beats/min, which was followed by 2 : 1 AV block associated with dyspnea and dizziness. The patient's coronary angiogram was normal, and the ergonovine provocation test was negative. Electrophysiological studies demonstrated rate-dependent intranodal AV block. The patient received implantation of a permanent dual chamber (DDD) pacemaker and had no further symptoms during the follow-up period.

Sinnhaftigkeit der digital-rektalen Untersuchung bei akutem Abdomen in der Notfallaufnahme

Physical examination of patients with undifferentiated abdominal pain (UAP) in the emergency room traditionally calls for digital rectal examination (DRE). Without a DRE, many textbooks deem a clinical examination incomplete. On the other hand, patients as well as physicians often feel uncomfortable with this breach of privacy involving a DRE. Especially emergency rooms do not offer an atmosphere where a relationship with the necessary mutual trust can be built up. In this light, the objective of this analysis is to assess the evidence for DRE via a systematic search of the relevant literature. A systematic search in Pubmed, Medline coupled with manual research laid the basis for the evaluation of relevant publications from January 1990 to March 2010. Keywords for the search were: "digital rectal examination" in combination with "acute abdominal pain", "acute abdomen" or "appendicitis". From the raw data of relevant publications, we extracted results into contingency tables and completed missing data. Above all parameters, we determined the likelihood ratios (LR) with corresponding 95 % confidence intervals to assess test quality. Opinions in the evaluated literature and many national and international textbooks diverge significantly on the necessity of DRE. Six studies question the significance of DRE when evaluating patients with undifferentiated abdominal pain and appendicitis, respectively. Out of these studies, five are prospective and one is retrospective. Overall, the diagnostic test quality of DRE was low in all studies with LR + in the range from 0.78 to 1.61 and LR - from 0.91 to 1.29, respectively. No diagnostic relevance for DRE in combination with acute abdominal pain was found in these studies. Furthermore, in none of the reviewed cases did DRE have a relevant impact on management. The recommendation of generally applying DRE in the emergency room needs to be questioned critically. No evidence for the necessity and significance was found in the reviewed literature. Independently, these findings do not touch on the unequivocal indication of the DRE as a tool for assessing other specific conditions as well as screening for prostate or rectal cancer.

Manifestações clínicas, radiológicas e laboratoriais em indivíduos com tuberculose pulmonar: estudo comparativo entre indivíduos HIV positivos e HIV negativos internados em um hospital de referência

To compare clinical, radiological, and laboratory characteristics of individuals with pulmonary tuberculosis co-infected or not with HIV. A cross-sectional study, in which signs and symptoms were assessed by anamnesis and physical examination in patients hospitalized with pulmonary tuberculosis. The results of sputum smear microscopy and culture for Mycobacterium tuberculosis, as well as hemoglobin levels and CD4+ T-cell counts, were obtained from medical records, and chest X-ray reports were consulted. We included 50 pulmonary tuberculosis patients, who were divided into two groups (HIV-positive and HIV-negative; n = 25 per group). The mean age of the participants was 38.4 ± 10.5 years; 46 (92%) were males; and 27 (54%) were White. Expectoration was presented by 21 (84%) and 13 (52%) of the patients in the HIV-negative and HIV-positive groups, respectively (p = 0.016). Radiological findings of cavitation were present in 10 (43%) and 2 (10%) of the patients in the HIV-negative and HIV-positive groups, respectively (p = 0.016), whereas an interstitial pattern was observed in 18 (78%) and 8 (40%), respectively (p = 0.012). The mean hemoglobin level was 11.1 ± 2.9 g/dL and 9.3 ± 2.2 g/dL in the HIV-negative and HIV-positive groups, respectively (p = 0.015). In our sample of tuberculosis patients, expectoration was less prevalent, hemoglobin levels were lower, and cavitation was less common, as was an interstitial pattern, among those co-infected with HIV than among those without HIV co-infection.

Ischemic Stroke Secondary to Aortic Dissection Following Rifle Butt Recoil ChestInjury: A Case Report

Ischemic stroke secondary to aortic dissection is not uncommon. We present a patient with left hemiplegia secondary to Stanford type A aortic dissection extending to the supra-aortic vessels, which was precipitated by rifle butt recoil chest injury. The diagnosis of aortic dissection was delayed due to various factors. Finally, the patient underwent successful Bentall procedure with complete resolution of symptoms. This case emphasizes the need for caution in the use of firearms for recreation and to take precautions in preventing such incidents. In addition, this case illustrates the need for prompt cardiovascular physical examination in patients presenting with stroke.

The Prognostic Values of the Admission Electrocardiography, Myocardial Injury Markers and Physical Examination in Patients with Acute Myocardial Infarction

Introduction Acute coronary syndromes (ACS) are leading life threatening causes of chest pain, which is one of the most common complaints in the emergency department (ED). The aim of the study was to demonstrate the usefulness of physical examination, ECG and cardiac markers to predict short term outcome of ACS patients. Methods A total of 1728 patients with chest pain were evaluated between 1st January 2003 and 31st December 2003 in the ED and 236 of the patients matched our study criteria. Results In the study group 184 patients were (78%) male and the mean age was 59.8±12.2 (range=4-92) years old. Age, Killip score, cardiac marker values, the time interval between the beginning of the chest pain and ED entry and the ECG changes were the studied variables. With the logistic regression analysis, Killip score and any rhythm other than normal sinus rhythm on the first ECG were found to be the only independent variables to predict early mortality (p=0.036 and p=0.033). Conclusion Simple measures in the ED such as ECG and serum markers of myocardial injury along with the thorough physical evaluation of the physician may predict early negative outcome.

The Predictability of Cold Findings Evaluated by Physical Examination in Patients with Acute Decompensated Heart Failure for the Long-Term Mortality

The Predictability of Cold Findings Evaluated by Physical Examination in Patients with Acute Decompensated Heart Failure for the Long-Term Mortality