title: Accuracy and reliability of palpation and percussion for detecting hepatomegaly: a rural hospital-based study.
abstract: BACKGROUND
  Palpation and percussion are standard bedside techniques used to diagnose hepatomegaly. Ultrasonography is a noninvasive and accurate method for measurement of liver size, but many patients in developing countries have limited access to it. We compared the accuracy of palpation and percussion in a rural population in central India, using ultrasonography as a reference standard.
  
  
  METHODS
  The study design was a blinded, cross-sectional analysis of a hospital-based case series. Three physicians, blind to clinical data and to each other's results, independently used palpation and percussion to detect hepatomegaly. Diagnostic accuracy was measured by computing sensitivity, specificity, and likelihood ratio values. Inter-physician agreement was assessed using the kappa statistic.
  
  
  RESULTS
  Of the 180 study patients, 36 (20%) had enlarged liver on ultrasonography. The likelihood ratios for findings at both palpation (2.2, 3.0, and 2.5 for the three physicians, respectively) and percussion (1.1 for all three physicians) as predictors of true hepatomegaly were low. The kappa values for inter-observer agreement between three physicians for the presence of hepatomegaly at palpation (=0.44-0.53) and percussion (=0.17-0.33) were low, indicating poor reliability of these techniques.
  
  
  CONCLUSIONS
  Clinical assessment of hepatomegaly by palpation and percussion lacks both accuracy and reliability.
authors.affiliation: Division of Epidemiology, University of California at Berkeley, Berkeley, CA 94720, USA.
authors.forename: Rajnish
authors.initials: R
authors.lastname: Joshi
authors.forename: Amandeep
authors.initials: A
authors.lastname: Singh
authors.forename: Namita
authors.initials: N
authors.lastname: Jajoo
authors.forename: Madhukar
authors.initials: M
authors.lastname: Pai
authors.forename: S P
authors.initials: SP
authors.lastname: Kalantri
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D004311:Double-Blind Method; D005260:Female; D006529:Hepatomegaly / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D006780:Hospitals, Rural; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010173:Palpation / Q000379:methods*; D010474:Percussion / Q000379:methods*; D010808:Physical Examination / Q000592:standards / Q000639:trends; D011237:Predictive Value of Tests; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler