The Rational Clinical Examination
David L. Simel, Drummond Rennie
Carotid Bruit
David L. Simel, Larry Goldstein
Make the Diagnosis: Carotid Bruit
Topics Discussed:
auscultation, carotid bruit, carotid stenosis, criterion standard comparisons (diagnostic tests), likelihood ratio, make the diagnosis, prior probability
Excerpt:
"It is hard for physicians to resist auscultating the neck. Perhaps
no physical finding in adults causes as much confusion as the presence
of the carotid bruit in asymptomatic patients. Most clinical research
suggests that there is a clear benefit to carotid endarterectomy
for patients with symptoms and a benefit (although likely small)
for asymptomatic patients. After ruling out patients for whom endarterectomy would not be
considered, 10% to 30% will have surgically amenable
carotid stenosis. There is variability in the estimates of the remaining
patients who will prove to have surgically correctable carotid stenosis.
The variability depends on the patient population, criteria for
determining surgical risk, and the threshold for defining an "important" stenosis.For patients 60 years or older, there is 1% to 10% probability
for carotid stenosis...."
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