title: Examiner dependence on physical diagnostic tests for the detection of splenomegaly: a prospective study with multiple observers.
abstract: OBJECTIVE
  To determine the reliability and validity of various physical diagnostic techniques (including three methods of palpation and three methods of percussion) in detecting ultrasonographically identified splenomegaly.
  
  
  METHODS
  Prospective, double-blind study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Twenty-seven hospitalized male patients with suspected human immunodeficiency virus (HIV) infection.
  
  
  METHODS
  Three methods of palpation (bimanual, ballottement, and palpation from above) and three methods of percussion (as described by Nixon, Castell, and Barkun et al.) were performed on each patient by eight examiners. Splenic ultrasonography was performed within 96 hours of admission.
  
  
  RESULTS
  The prevalence of splenomegaly by ultrasonography (defined as a spleen > or = 13 cm on the longitudinal scan) in this population was 33.3%. The sensitivity and specificity of each method of palpation and percussion varied by examiner. The ranges of sensitivity across examiners for the three methods of palpation and the three methods of percussion were 0%-64.3% and 7.7%-75%, respectively. The ranges of specificity across examiners for the three methods of palpation and the three methods of percussion were 50%-100% and 60%-100%, respectively. Likelihood ratios pooled across observers revealed that for palpation, palpation from above, and percussion, Castell's method had the highest likelihood ratios [LR = 2.66 and 1.97, respectively; 95% CI = 1.52-4.64 and 1.22-3.19, respectively]. A combination of tests (either palpation or percussion) increased the diagnostic accuracy.
  
  
  CONCLUSIONS
  Physical diagnostic techniques for the detection of splenomegaly are relatively insensitive but specific. In this study there was high interobserver variability, which did not appear to be associated to the level of experience. Combining tests increases diagnostic accuracy.
authors.affiliation: Department of Biology, University of California, San Diego.
authors.forename: S G
authors.initials: SG
authors.lastname: Tamayo
authors.forename: L S
authors.initials: LS
authors.lastname: Rickman
authors.forename: W C
authors.initials: WC
authors.lastname: Mathews
authors.forename: S C
authors.initials: SC
authors.lastname: Fullerton
authors.forename: A E
authors.initials: AE
authors.lastname: Bartok
authors.forename: J T
authors.initials: JT
authors.lastname: Warner
authors.forename: D W
authors.initials: DW
authors.lastname: Feigal
authors.forename: D G
authors.initials: DG
authors.lastname: Arnstein
authors.forename: N S
authors.initials: NS
authors.lastname: Callandar
authors.forename: K D
authors.initials: KD
authors.lastname: Lyche
mesh_terms: D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010173:Palpation; D010474:Percussion; D010808:Physical Examination; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013154:Spleen / Q000000981:diagnostic imaging; D013163:Splenomegaly / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014463:Ultrasonography