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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Murmur, Diastolic
Niteesh K. Choudhry, Edward E. Etchells
Accuracy of the Examination for Aortic Regurgitation


Topics Discussed: aortic valve insufficiency, diagnostic process, diastolic murmur, doppler echocardiography, finding the evidence, interobserver agreement

Excerpt: "To identify articles pertaining to the precision and accuracy of the physical examination for AR, we used standard methods for conducting research overviews.24 Our data collection strategy involved 3 steps and was deliberately broad to reduce the possibility of overlooking important articles. First, we searched MEDLINE for English-language articles published from 1966 through July 1997, using a structured search strategy (available on request from the authors). Second, we manually reviewed potentially relevant articles and their reference lists. Third, we contacted the authors of relevant studies for additional information. Studies were excluded if they were review articles, involved patients younger than 18 years, were small (ie, <20 participants), involved prosthetic heart valves, had no clinical examination performed or reported, or had no acceptable reference standard (Doppler echocardiography or cardiac catheterization).Precision refers to agreement regarding a particular clinical finding between different physicians (interobserver) or between multiple assessments by the same physician (intraobserver). The precision of the clinical examination for diastolic murmurs has been evaluated in usual clinical situations by auscultating patients28,29 or in controlled nonclinical circumstances by listening to recorded audiotapes (Table 32-2).30..."
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