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Background: Chest physical examination techniques are taught in academia, but their usefulness in the evaluation and diagnosis of patients in the clinical setting is controversial. Objective: To investigate the accuracy of physical examination techniques and their reliability in diagnosing community acquired pneumonia (CAP) and suggest a modified teaching approach to be used in academia. Design: Systematic Literature Review. Methods: Database search of PubMed and Google Scholar using the search terms “prediction of pneumonia in adults” and “prediction rule for pulmonary infiltrates.” Filters were implemented to include articles that only dealt with human subjects and were full text. Articles were excluded if the patient population was not desired, if the article focused on symptoms instead of clinical findings, or if the article was a meta-analysis. Results: Gennis et al. found that decreased breath sounds, rales, and rhonchi are significantly associated with pneumonia. Heckerling et al. found that dullness to percussion, bronchial breath sounds, decreased breath sounds, egophony, rales, and rhonchi were all significantly associated with pneumonia. Diehr et al. found that increased fremitus, dullness to percussion, egophony, pleural friction rub, and rales were significantly associated with pneumonia. Conclusion: The most valuable examination technique in detecting pneumonia was rales. Wheezes were relatively not useful. Overall, performing a meticulous lung and thorax examination contributes to identifying a diagnostic hypothesis; however, the physical examination is not sufficiently accurate to rule in or rule out pneumonia on its own. If diagnostic certainty is required for the management of a patient with suspected pneumonia, chest radiographs should be obtained. In academia, teaching examination techniques with the highest diagnostic yield should be the cornerstone of a teacher’s instruction.
Tordoff AL, Williams LA. Community-Acquired Pneumonia in Adults: Diagnostic Reliability of Physical Examination Techniques and their Teaching in Academia. JMU Scholarly Commons Physician Assistant Capstones. https://commons.lib.jmu.edu/pacapstones/44/. Published December 12, 2018.
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