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Bernd M Leimenstoll - One of the best experts on this subject based on the ideXlab platform.
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can airway obstruction be estimated by Lung Auscultation in an emergency room setting
Respiratory Medicine, 2006Co-Authors: Jorg D Leuppi, Thomas Dieterle, Gian Koch, Benedict Martina, Michael Tamm, Andre P Perruchoud, Irene Wildeisen, Bernd M LeimenstollAbstract:Summary Objective Lung Auscultation is a central part of the physical examination at hospital admission. In this study, the physicians' estimation of airway obstruction by Auscultation was determined and compared with the degree of airway obstruction as measured by FEV 1 /FVC values. Methods Two hundred and thirty-three patients consecutively admitted to the medical emergency room with chest problems were included. After taking their history, patients were auscultated by an Internal Medicine registrar. The degree of airway obstruction had to be estimated (0=no, 1=mild, 2=moderate and 3=severe obstructed) and then spirometry was performed. Airway obstruction was defined as a ratio of FEV 1 /FVC 1 /FVC as mild (FEV 1 /FVC 50%), moderate (FEV 1 /FVC 30%) and severe (FEV 1 /FVC Results One hundred and thirty-five patients (57.9%) had no sign of airway obstruction (FEV 1 /FVC >70%). Spirometry showed a mild obstruction in 51 patients (21.9%), a moderate obstruction in 27 patients (11.6%) and a severe obstruction in 20 patients (8.6%). There was a weak but significant correlation between FEV 1 /FVC and the Auscultation-based estimation of airway obstruction in Internal Medicine Registrars (Spearman's ρ =0.328; P 1 /FVC >70%), airway obstruction was wrongly estimated as mild in 42 patients, as moderate in 34 patients and as severe in 6 patients, respectively. By performing multiple logistic regression, normal Lung Auscultation was a significant and independent predictor for not having an airway obstruction (OR 2.48 (1.43–4.28); P = 0.0 0 1 ). Conclusion Under emergency room conditions, physicians can quite accurately exclude airway obstruction by Auscultation. Normal Lung Auscultation is an independent predictor for not having an airway obstruction. However, airway obstruction is often overestimated by Auscultation; thus, spirometry should be performed.
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diagnostic value of Lung Auscultation in an emergency room setting
Swiss Medical Weekly, 2005Co-Authors: Jorg D Leuppi, Thomas Dieterle, Gian Koch, Benedict Martina, Michael Tamm, Andre P Perruchoud, Irene Wildeisen, Bernd M LeimenstollAbstract:Background In daily routine, physicians use history, physical examination and technology-based information such as laboratory tests and imaging studies to diagnose the patients' disease. We determined the diagnostic value of Lung Auscultation in patients admitted to the Medical emergency room with chest symptoms. Methods Two-hundred-and forty-three consecutive patients (137 males), mean age 59.2 years were included. Internal Medicine registrars had to make a presumptive diagnosis, 1) after having taken the history and 2) after having auscultated the Lungs. Thereafter, routine diagnostic procedures were performed. The estimated diagnosis was compared with the final diagnosis based on the written report to the Family Practitioner. Results Two-hundred-eighty-seven diagnoses were made. Eighteen percent of patients suffered from left heart failure, 13% from unexplained chest pain, 10.5% from chest wall pain, and 10.5% from pneumonia. Forty-one percent of the diagnoses were already correct when based only on the patient's history. Lung Auscultation improved the diagnostic yield only in 1% and worsened it in another 3%. By multiple logistic regression, normal Lung Auscultation (OR 0.12 [95CI% 0.053-0.29]) was the independent predictor for not having a Lung or heart disease. However, elevation of B-type natiuretic peptide (BNP) (OR 1.16 per 100 pg/ml (95CI% 1.004-1.35), wheezing (OR 0.023 [0.002-0.33]) and pCO2 (OR 0.25 (0.10-0.621) were independent predictors for having a heart disease, whereas wheezing (OR 7.41 [3.26-16.83]) and CRP (OR 1.008 per 10 units [1.003-1.014]) were risk factors for having a Lung disease. Conclusion In contrast to history taking, abnormal Lung Auscultation does not appear to contribute considerably to the final diagnosis in patients presenting with chest symptoms in an emergency room setting. However, normal Lung Auscultation is a valuable predictor for not having a Lung or heart disease, whereas wheezing is a predictor for having a Lung disease and not having a heart disease.
Jorg D Leuppi - One of the best experts on this subject based on the ideXlab platform.
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can airway obstruction be estimated by Lung Auscultation in an emergency room setting
Respiratory Medicine, 2006Co-Authors: Jorg D Leuppi, Thomas Dieterle, Gian Koch, Benedict Martina, Michael Tamm, Andre P Perruchoud, Irene Wildeisen, Bernd M LeimenstollAbstract:Summary Objective Lung Auscultation is a central part of the physical examination at hospital admission. In this study, the physicians' estimation of airway obstruction by Auscultation was determined and compared with the degree of airway obstruction as measured by FEV 1 /FVC values. Methods Two hundred and thirty-three patients consecutively admitted to the medical emergency room with chest problems were included. After taking their history, patients were auscultated by an Internal Medicine registrar. The degree of airway obstruction had to be estimated (0=no, 1=mild, 2=moderate and 3=severe obstructed) and then spirometry was performed. Airway obstruction was defined as a ratio of FEV 1 /FVC 1 /FVC as mild (FEV 1 /FVC 50%), moderate (FEV 1 /FVC 30%) and severe (FEV 1 /FVC Results One hundred and thirty-five patients (57.9%) had no sign of airway obstruction (FEV 1 /FVC >70%). Spirometry showed a mild obstruction in 51 patients (21.9%), a moderate obstruction in 27 patients (11.6%) and a severe obstruction in 20 patients (8.6%). There was a weak but significant correlation between FEV 1 /FVC and the Auscultation-based estimation of airway obstruction in Internal Medicine Registrars (Spearman's ρ =0.328; P 1 /FVC >70%), airway obstruction was wrongly estimated as mild in 42 patients, as moderate in 34 patients and as severe in 6 patients, respectively. By performing multiple logistic regression, normal Lung Auscultation was a significant and independent predictor for not having an airway obstruction (OR 2.48 (1.43–4.28); P = 0.0 0 1 ). Conclusion Under emergency room conditions, physicians can quite accurately exclude airway obstruction by Auscultation. Normal Lung Auscultation is an independent predictor for not having an airway obstruction. However, airway obstruction is often overestimated by Auscultation; thus, spirometry should be performed.
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diagnostic value of Lung Auscultation in an emergency room setting
Swiss Medical Weekly, 2005Co-Authors: Jorg D Leuppi, Thomas Dieterle, Gian Koch, Benedict Martina, Michael Tamm, Andre P Perruchoud, Irene Wildeisen, Bernd M LeimenstollAbstract:Background In daily routine, physicians use history, physical examination and technology-based information such as laboratory tests and imaging studies to diagnose the patients' disease. We determined the diagnostic value of Lung Auscultation in patients admitted to the Medical emergency room with chest symptoms. Methods Two-hundred-and forty-three consecutive patients (137 males), mean age 59.2 years were included. Internal Medicine registrars had to make a presumptive diagnosis, 1) after having taken the history and 2) after having auscultated the Lungs. Thereafter, routine diagnostic procedures were performed. The estimated diagnosis was compared with the final diagnosis based on the written report to the Family Practitioner. Results Two-hundred-eighty-seven diagnoses were made. Eighteen percent of patients suffered from left heart failure, 13% from unexplained chest pain, 10.5% from chest wall pain, and 10.5% from pneumonia. Forty-one percent of the diagnoses were already correct when based only on the patient's history. Lung Auscultation improved the diagnostic yield only in 1% and worsened it in another 3%. By multiple logistic regression, normal Lung Auscultation (OR 0.12 [95CI% 0.053-0.29]) was the independent predictor for not having a Lung or heart disease. However, elevation of B-type natiuretic peptide (BNP) (OR 1.16 per 100 pg/ml (95CI% 1.004-1.35), wheezing (OR 0.023 [0.002-0.33]) and pCO2 (OR 0.25 (0.10-0.621) were independent predictors for having a heart disease, whereas wheezing (OR 7.41 [3.26-16.83]) and CRP (OR 1.008 per 10 units [1.003-1.014]) were risk factors for having a Lung disease. Conclusion In contrast to history taking, abnormal Lung Auscultation does not appear to contribute considerably to the final diagnosis in patients presenting with chest symptoms in an emergency room setting. However, normal Lung Auscultation is a valuable predictor for not having a Lung or heart disease, whereas wheezing is a predictor for having a Lung disease and not having a heart disease.
Josef T. Prchal - One of the best experts on this subject based on the ideXlab platform.
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Sickle cell acute chest syndrome associated with parvovirus B19 infection: case series and review.
American journal of hematology, 1996Co-Authors: Elizabeth A. Lowenthal, Alan Wells, Peter D. Emanuel, Rick Player, Josef T. PrchalAbstract:Acute Chest Syndrome (ACS) continues to be a major source of morbidity and mortality among patients with sickle cell disease. It is characterized by the presence of pleutitic chest pain, fever, rales on Lung Auscultation, and pulmonary infiltrates on chest X-ray [Castro et al: Blood 84:643–649, 1994]. The pathophysiology of this disorder remains poorly understood leading to the descriptive term “Acute Chest Syndrome” designated by Charache et al. [Arch Intern Med 139:67–69, 1979]. Typical bacterial pathogens are seldom isolated in adults, although they play a significant role in the pathogenesis of this entity in children. Until recently, the technology to accurately study viral infection as a precipitating cause of ACS has been unavailable. Parvovirus B19 is being increasingly recognized as an important human pathogen, and has been established as the cause of transient “aplastic crisis” in patients with sickle cell disease [Saarlen et al: Blood 67:11411–11417, 1986; Young: Sem Hematol 25:159–172, 1988]. We present three patients with hemoglobin SC variant of sickle cell disease who developed ACS in association with acute parvovirus B19 infection, one of which died of respiratory failure. Parvovirus B19 infection was established by polymerase chain reaction for parvovirus B19 DNA, and the presence of parvovirus B19 specific IgM antibodies. These cases suggest that parvovirus B19 may be associated with more than self-limited illness in patients with sickle cell disease, and that this ubiquitous virus may merit further study as a precipitating cause of ACS. © 1996 Wiley-Liss, Inc.
Gian Koch - One of the best experts on this subject based on the ideXlab platform.
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can airway obstruction be estimated by Lung Auscultation in an emergency room setting
Respiratory Medicine, 2006Co-Authors: Jorg D Leuppi, Thomas Dieterle, Gian Koch, Benedict Martina, Michael Tamm, Andre P Perruchoud, Irene Wildeisen, Bernd M LeimenstollAbstract:Summary Objective Lung Auscultation is a central part of the physical examination at hospital admission. In this study, the physicians' estimation of airway obstruction by Auscultation was determined and compared with the degree of airway obstruction as measured by FEV 1 /FVC values. Methods Two hundred and thirty-three patients consecutively admitted to the medical emergency room with chest problems were included. After taking their history, patients were auscultated by an Internal Medicine registrar. The degree of airway obstruction had to be estimated (0=no, 1=mild, 2=moderate and 3=severe obstructed) and then spirometry was performed. Airway obstruction was defined as a ratio of FEV 1 /FVC 1 /FVC as mild (FEV 1 /FVC 50%), moderate (FEV 1 /FVC 30%) and severe (FEV 1 /FVC Results One hundred and thirty-five patients (57.9%) had no sign of airway obstruction (FEV 1 /FVC >70%). Spirometry showed a mild obstruction in 51 patients (21.9%), a moderate obstruction in 27 patients (11.6%) and a severe obstruction in 20 patients (8.6%). There was a weak but significant correlation between FEV 1 /FVC and the Auscultation-based estimation of airway obstruction in Internal Medicine Registrars (Spearman's ρ =0.328; P 1 /FVC >70%), airway obstruction was wrongly estimated as mild in 42 patients, as moderate in 34 patients and as severe in 6 patients, respectively. By performing multiple logistic regression, normal Lung Auscultation was a significant and independent predictor for not having an airway obstruction (OR 2.48 (1.43–4.28); P = 0.0 0 1 ). Conclusion Under emergency room conditions, physicians can quite accurately exclude airway obstruction by Auscultation. Normal Lung Auscultation is an independent predictor for not having an airway obstruction. However, airway obstruction is often overestimated by Auscultation; thus, spirometry should be performed.
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diagnostic value of Lung Auscultation in an emergency room setting
Swiss Medical Weekly, 2005Co-Authors: Jorg D Leuppi, Thomas Dieterle, Gian Koch, Benedict Martina, Michael Tamm, Andre P Perruchoud, Irene Wildeisen, Bernd M LeimenstollAbstract:Background In daily routine, physicians use history, physical examination and technology-based information such as laboratory tests and imaging studies to diagnose the patients' disease. We determined the diagnostic value of Lung Auscultation in patients admitted to the Medical emergency room with chest symptoms. Methods Two-hundred-and forty-three consecutive patients (137 males), mean age 59.2 years were included. Internal Medicine registrars had to make a presumptive diagnosis, 1) after having taken the history and 2) after having auscultated the Lungs. Thereafter, routine diagnostic procedures were performed. The estimated diagnosis was compared with the final diagnosis based on the written report to the Family Practitioner. Results Two-hundred-eighty-seven diagnoses were made. Eighteen percent of patients suffered from left heart failure, 13% from unexplained chest pain, 10.5% from chest wall pain, and 10.5% from pneumonia. Forty-one percent of the diagnoses were already correct when based only on the patient's history. Lung Auscultation improved the diagnostic yield only in 1% and worsened it in another 3%. By multiple logistic regression, normal Lung Auscultation (OR 0.12 [95CI% 0.053-0.29]) was the independent predictor for not having a Lung or heart disease. However, elevation of B-type natiuretic peptide (BNP) (OR 1.16 per 100 pg/ml (95CI% 1.004-1.35), wheezing (OR 0.023 [0.002-0.33]) and pCO2 (OR 0.25 (0.10-0.621) were independent predictors for having a heart disease, whereas wheezing (OR 7.41 [3.26-16.83]) and CRP (OR 1.008 per 10 units [1.003-1.014]) were risk factors for having a Lung disease. Conclusion In contrast to history taking, abnormal Lung Auscultation does not appear to contribute considerably to the final diagnosis in patients presenting with chest symptoms in an emergency room setting. However, normal Lung Auscultation is a valuable predictor for not having a Lung or heart disease, whereas wheezing is a predictor for having a Lung disease and not having a heart disease.
Irene Wildeisen - One of the best experts on this subject based on the ideXlab platform.
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can airway obstruction be estimated by Lung Auscultation in an emergency room setting
Respiratory Medicine, 2006Co-Authors: Jorg D Leuppi, Thomas Dieterle, Gian Koch, Benedict Martina, Michael Tamm, Andre P Perruchoud, Irene Wildeisen, Bernd M LeimenstollAbstract:Summary Objective Lung Auscultation is a central part of the physical examination at hospital admission. In this study, the physicians' estimation of airway obstruction by Auscultation was determined and compared with the degree of airway obstruction as measured by FEV 1 /FVC values. Methods Two hundred and thirty-three patients consecutively admitted to the medical emergency room with chest problems were included. After taking their history, patients were auscultated by an Internal Medicine registrar. The degree of airway obstruction had to be estimated (0=no, 1=mild, 2=moderate and 3=severe obstructed) and then spirometry was performed. Airway obstruction was defined as a ratio of FEV 1 /FVC 1 /FVC as mild (FEV 1 /FVC 50%), moderate (FEV 1 /FVC 30%) and severe (FEV 1 /FVC Results One hundred and thirty-five patients (57.9%) had no sign of airway obstruction (FEV 1 /FVC >70%). Spirometry showed a mild obstruction in 51 patients (21.9%), a moderate obstruction in 27 patients (11.6%) and a severe obstruction in 20 patients (8.6%). There was a weak but significant correlation between FEV 1 /FVC and the Auscultation-based estimation of airway obstruction in Internal Medicine Registrars (Spearman's ρ =0.328; P 1 /FVC >70%), airway obstruction was wrongly estimated as mild in 42 patients, as moderate in 34 patients and as severe in 6 patients, respectively. By performing multiple logistic regression, normal Lung Auscultation was a significant and independent predictor for not having an airway obstruction (OR 2.48 (1.43–4.28); P = 0.0 0 1 ). Conclusion Under emergency room conditions, physicians can quite accurately exclude airway obstruction by Auscultation. Normal Lung Auscultation is an independent predictor for not having an airway obstruction. However, airway obstruction is often overestimated by Auscultation; thus, spirometry should be performed.
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diagnostic value of Lung Auscultation in an emergency room setting
Swiss Medical Weekly, 2005Co-Authors: Jorg D Leuppi, Thomas Dieterle, Gian Koch, Benedict Martina, Michael Tamm, Andre P Perruchoud, Irene Wildeisen, Bernd M LeimenstollAbstract:Background In daily routine, physicians use history, physical examination and technology-based information such as laboratory tests and imaging studies to diagnose the patients' disease. We determined the diagnostic value of Lung Auscultation in patients admitted to the Medical emergency room with chest symptoms. Methods Two-hundred-and forty-three consecutive patients (137 males), mean age 59.2 years were included. Internal Medicine registrars had to make a presumptive diagnosis, 1) after having taken the history and 2) after having auscultated the Lungs. Thereafter, routine diagnostic procedures were performed. The estimated diagnosis was compared with the final diagnosis based on the written report to the Family Practitioner. Results Two-hundred-eighty-seven diagnoses were made. Eighteen percent of patients suffered from left heart failure, 13% from unexplained chest pain, 10.5% from chest wall pain, and 10.5% from pneumonia. Forty-one percent of the diagnoses were already correct when based only on the patient's history. Lung Auscultation improved the diagnostic yield only in 1% and worsened it in another 3%. By multiple logistic regression, normal Lung Auscultation (OR 0.12 [95CI% 0.053-0.29]) was the independent predictor for not having a Lung or heart disease. However, elevation of B-type natiuretic peptide (BNP) (OR 1.16 per 100 pg/ml (95CI% 1.004-1.35), wheezing (OR 0.023 [0.002-0.33]) and pCO2 (OR 0.25 (0.10-0.621) were independent predictors for having a heart disease, whereas wheezing (OR 7.41 [3.26-16.83]) and CRP (OR 1.008 per 10 units [1.003-1.014]) were risk factors for having a Lung disease. Conclusion In contrast to history taking, abnormal Lung Auscultation does not appear to contribute considerably to the final diagnosis in patients presenting with chest symptoms in an emergency room setting. However, normal Lung Auscultation is a valuable predictor for not having a Lung or heart disease, whereas wheezing is a predictor for having a Lung disease and not having a heart disease.
