The efficacy of history and physical exam for diagnosis

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Maddaford, Graham
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Purpose: This literature review looks to analyze the reliability of physical exams, along with signs and symptoms when determining the diagnosis. Methods: To answer this question a literature review was performed looking at the reliability of the Lachman test, the S3 heart sound, and the Alvarado score for aiding in determining the diagnosis Results: The Lachman test was good for ruling in ACL disruption with a specificity from (0.91- 0.97) and poorly for ruling out ACL disruption with a sensitivity ranging from (0.70-0.87) The presence of an S3 heart sound is a highly specific test for the presence of heart failure with a specificity ranging from 0.88(18) to 0.99(9) and a patient with an S3 there is an LR of 11 that the patient is experiencing heart failure. In terms of diagnostic accuracy, the Alvarado score cut of a point off 5 was excellent for ruling out appendicitis with sensitivities reaching 99% overall with each subgroup being 96% men, 99% woman, and 99% in children. Conclusion: It was not shown that physical exam findings along with clinical suspicion cannot replace advanced imaging testing and specific blood work testing. Physical exam findings for clinical suspicion should remain in standard practice when examining patients and should be considered before ordering multiple tests as physical exams can provide a lot of information before the testing results come back.
Physical exams, Diagnosis