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Diagnostic accuracy of clinical tests for the detection of splenomegaly

Publication ,  Journal Article
Stewart, KR; Derck, AM; Long, KL; Learman, K; Cook, C
Published in: Physical Therapy Reviews
June 1, 2013

Background: Due to common pain referral patterns, splenomegaly may present similarly to other conditions commonly seen in the physical therapy setting, and may become deadly if undetected. Therefore, when considering a differential diagnosis for left upper quadrant pain and the appropriateness of physical therapy intervention, it is imperative to screen for splenomegaly. Objective: To summarize the research on the diagnostic accuracy of clinical examination tests for the detection of splenomegaly to determine if physical therapists and other health care providers can rely upon these tests to screen for splenomegaly. Methods: A computer-based search strategy was conducted, using PubMed (MESH terms), Cochrane Central Register of Controlled Trials, ProQuest Nursing & Allied Health Source, SPORTDiscus, CINAHL, and SCOPUS databases (key words). Selection required: (1) an assessment of individual clinical measures of splenomegaly, (2) diagnostic accuracy measures for clinical tests, (3) an acceptable reference standard for comparison, and (4) a case–control or case-based case–control design. Electronic and hand search limits included English-written and human studies. Results: The studies included Nixon’s percussion, Castell’s percussion, percussion of Traube’s space, bimanual palpation of the spleen, ballottement of the spleen, Middleton’s maneuver, and the combination of percussion and palpation testing. For each clinical test from each study, diagnostic accuracy measures were reported as well as reliability, when available. Quality scores were tabulated for each study using the QUADAS instrument and studies were dichotomized into high (≧10/14) or low (<10/14) quality based on QUADAS scores. Thirteen articles qualified for inclusion, of which four were identified as high quality. When comparing high quality studies, palpation techniques yielded specificity values of 82–93 and sensitivity values of 31–85·6, whereas percussion techniques presented with lower values in both specificity (32·6–87) and sensitivity (22–85·7). Conclusion: There is moderate evidence for the use of palpation tests for ruling in splenomegaly and limited evidence to support the use of palpation or percussion techniques for ruling out this condition. More high quality studies are needed.

Duke Scholars

Published In

Physical Therapy Reviews

DOI

EISSN

1743-288X

ISSN

1083-3196

Publication Date

June 1, 2013

Volume

18

Issue

3

Start / End Page

173 / 184

Related Subject Headings

  • 1106 Human Movement and Sports Sciences
  • 1103 Clinical Sciences
 

Citation

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ICMJE
MLA
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Stewart, K. R., Derck, A. M., Long, K. L., Learman, K., & Cook, C. (2013). Diagnostic accuracy of clinical tests for the detection of splenomegaly. Physical Therapy Reviews, 18(3), 173–184. https://doi.org/10.1179/1743288X13Y.0000000081
Stewart, K. R., A. M. Derck, K. L. Long, K. Learman, and C. Cook. “Diagnostic accuracy of clinical tests for the detection of splenomegaly.” Physical Therapy Reviews 18, no. 3 (June 1, 2013): 173–84. https://doi.org/10.1179/1743288X13Y.0000000081.
Stewart KR, Derck AM, Long KL, Learman K, Cook C. Diagnostic accuracy of clinical tests for the detection of splenomegaly. Physical Therapy Reviews. 2013 Jun 1;18(3):173–84.
Stewart, K. R., et al. “Diagnostic accuracy of clinical tests for the detection of splenomegaly.” Physical Therapy Reviews, vol. 18, no. 3, June 2013, pp. 173–84. Scopus, doi:10.1179/1743288X13Y.0000000081.
Stewart KR, Derck AM, Long KL, Learman K, Cook C. Diagnostic accuracy of clinical tests for the detection of splenomegaly. Physical Therapy Reviews. 2013 Jun 1;18(3):173–184.

Published In

Physical Therapy Reviews

DOI

EISSN

1743-288X

ISSN

1083-3196

Publication Date

June 1, 2013

Volume

18

Issue

3

Start / End Page

173 / 184

Related Subject Headings

  • 1106 Human Movement and Sports Sciences
  • 1103 Clinical Sciences