Utility Of Clinical Examination Research Articles

Utility of clinical examination and CT scan in assessment of penetrating neck trauma.

Managing penetrating injuries adequately and effectively depends a great deal on proper assessment of the injury. This study carried out was done at The Aga Khan University Hospital to assess the role of clinical examination and CT scan imaging in evaluation of penetrating neck injuries. A total of 68 students were included, with ages ranging from 3 to 74 years. The involved zones and the injured structures were noted. Results showed a high sensitivity of clinical examination in assessing vascular (81%) and airway trauma (77%), with a low sensitivity for esophageal trauma (34%). For CT scan the sensitivity was 90% for vascular trauma, 83% for airway trauma and 53% for esophageal injuries. Clinical findings and CT scan imaging are important assessment tools for evaluation of penetrating neck traumas, with a high sensitivity for vascular and airway injuries.

Utility of Clinical Examination in the Diagnosis of Emergency Department Patients Admitted to the Department of Medicine of an Academic Hospital

Utility of Clinical Examination in the Diagnosis of Emergency Department Patients Admitted to the Department of Medicine of an Academic Hospital

The utility of clinical examination in the diagnosis of medial meniscus injury in comparison with arthroscopic findings

A prospective study was conducted to evaluate the utility of clinical meniscal tests (joint line tenderness, McMurray test, Apley test and Steinmann I sign) in the diagnosis of medial meniscus injury. The sensitivity, specificity and diagnostic accuracy of these tests were calculated in comparison with arthroscopic findings in 50 patients presented to us between January 2005 and January 2006 with knee pain and clinical manifestations of meniscal injury. The arthroscopy revealed that 32 patients (30 males and 2 females, aged 19–39 with mean of 27 years) had medial meniscus injury. Joint line tenderness showed the best diagnostic accuracy (80%) while Steinmann I sign had promising diagnostic characteristics. Similar to previous reports, the present study confirmed that caution should be used when interpreting the McMurray and Apley tests in the diagnosis of medial meniscus injury.

Pelvic Ring Fractures: Utility of Clinical Examination in Patients with Impaired Consciousness or Tracheal Intubation.

To define the diagnostic accuracy of clinical examination in patients with impaired consciousness or endotracheal intubation to detect pelvic ring fractures and to identify those with severe bleeding. Included in this prospective data collection with retrolective data analysis were a consecutive series of blunt trauma victims with either a Glasgow Coma Scale ≤ 13 or tracheal intubation. Clinical examination comprised testing for stability of the iliac wings. From 784 subjects (injury severity score 23.3 ± 17.4) 93 patients (11.9%) were found to have a pelvic ring fracture. Clinical instability of the pelvic ring was found in 42 patients. There was only one false positive. Fifty-two fractures could not be identified by clinical examination, including nine fractures (17%) that required surgical fracture stabilization (sensitivity of clinical examination 44.1%). Seventeen fractures (18.3%) were associated with a blood loss larger than 20% of circulating blood volume. Sixteen of those were identified by clinical instability of the pelvic ring (sensitivity 94.1%, specificity 97.0%, positive predictive value 38.1%, negative predictive value 99.9%). Clinical examination for stability of the pelvis in this selected group of patients missed a significant number of pelvic ring fractures including fractures that require surgical stabilization. The finding of a clinically unstable identifies most of the patients with the pelvic ring fracture being a major source of bleeding. A stable pelvis makes pelvic ring fracture as being the source of bleeding quite unlikely.

The utility of clinical examination in screening for pelvic fractures in blunt trauma.

Current recommendations of the American College of Surgeons Advanced Trauma Life Support course is routine radiographic screening of the pelvis for all patients who suffer blunt torso trauma. The purpose of this study is to evaluate in a prospective manner the sensitivity of clinical examination as a screening modality for pelvic fractures in awake and alert blunt trauma patients. During a 32-month period, 2,176 consecutive blunt trauma patients who presented with Glasgow Coma Scores of 14 or 15 were evaluated at an urban Level I trauma center. Clinical examination of all patients was prospectively performed by trauma resident housestaff. The clinical examination of each patient was documented in a study form before performance of a standard anterior-posterior (A-P) pelvic x-ray. We evaluated 2,176 blunt trauma patients, 97 (4.5%) of whom were diagnosed with pelvic fracture. There were seven missed injuries on clinical examination (sensitivity 93%). None of the missed injuries on clinical examination required surgical intervention. The sensitivity of A-P pelvic x-ray was 87%, with 13 missed injuries. There were 463 patients who entered with ethanol levels equal or greater than 100 mg/dL (range 100 to 480 mg/dL). There were 20 pelvic fractures diagnosed in this group, with only 1 missed injury on clinical examination (sensitivity 95%). 1) Clinical examination of the pelvis can reliably rule out significant pelvic fracture in the awake and alert blunt trauma patient. 2) The addition of routine A-P pelvic x-ray does not improve the sensitivity in diagnosis of surgically significant pelvic fractures nor does it have significant impact on outcomes of pelvic fracture patients. 3) Elevated ethanol level is not a contraindication to use of clinical examination as a screening modality for pelvic fractures in the awake and alert blunt trauma patient.