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Did any of you see this abstract? Does everyone do the obligatory cardiac, abdominal, and lung exams, or are some of you just keeping the exam focused to the chief complaint? If so, are your exams always that focused or only for certain complaints? just wondering...
Annals of EM
Volume 46, Issue 3 (Supplement), Page 12 (September 2005)
The Clinical Impact of Cardiac, Abdominal, and Lung Exams for Emergency Department Patients with Minor Chief Complaints
Study Objectives: The value of the cardiac, abdominal, and lung physical exam (CALE) in emergency department (ED) patients with minor isolated chief complaints (MICCs), such as ankle sprain or finger laceration, has not been established. We sought to determine the prevalence of the performance of CALEs on ED patients with MICCs, and to determine the clinical impact of performing CALEs in this setting.
Methods: This prospective observational study was conducted at an urban ED (70,000 patients/year) with a 4-year Emergency Medicine (EM) residency. Inclusion MICCs such as laceration, ear ache, and foot pain were selected a priori to reflect conditions unlikely to necessitate a CALE in evaluation of the MICCs themselves. All patients presenting to the ED during 1 week blocks (one week per month from 4/03-9/03) were screened for inclusion MICCs and evaluated. Using a standardized chart extraction tool, blinded assistants reviewed charts for documentation of 1) CALEs; 2) Abnormal CALE findings; and 3) Additional work-up or testing related to abnormal CALE findings.
Results: 297 patients met study inclusion/exclusion criteria; 63% were male, 50% were African-American, and the mean age was 36.4 years. All patients were seen primarily by EM residents. Among chief complaints, 40% were musculoskeletal, 30% were dermatologic or wound-care related, 13% were ophthalmologic, and 11% were dental or ENT-related. Cardiac exams were performed on 71% with abnormalities noted in 5 (2.3%) of patients, including tachycardia (2), peripheral edema (2), and murmur (1). One EKG was performed due to tachycardia and the patient was discharged home. Lung exams were performed on 82% with abnormality noted in 1 (0.4%) of patients_slight wheezing; no bronchodilators given and no chest xray taken. Abdominal exams were performed on 46% with abnormalities noted in 2 (1.4%) of patients--a superficial abrasion and known ascites; neither prompted other investigation or therapy. Among the 591 total cardiac, lung and abdominal exams performed, 8 (1.4%; 95% CI 0.7 - 2.7) were abnormal and only 1 (0.1%; 95% CI 0 - 0.1) finding led to further testing; none led to intervention or change in therapy.
Conclusions: In ED patients with MICCs, abnormal CALE findings are unusual and rarely lead to further testing or change in management. The practice of routine CALEs for ED patients with MICCs is not supported and warrants further investigation in a randomized outcome based study.
Annals of EM
Volume 46, Issue 3 (Supplement), Page 12 (September 2005)
The Clinical Impact of Cardiac, Abdominal, and Lung Exams for Emergency Department Patients with Minor Chief Complaints
Study Objectives: The value of the cardiac, abdominal, and lung physical exam (CALE) in emergency department (ED) patients with minor isolated chief complaints (MICCs), such as ankle sprain or finger laceration, has not been established. We sought to determine the prevalence of the performance of CALEs on ED patients with MICCs, and to determine the clinical impact of performing CALEs in this setting.
Methods: This prospective observational study was conducted at an urban ED (70,000 patients/year) with a 4-year Emergency Medicine (EM) residency. Inclusion MICCs such as laceration, ear ache, and foot pain were selected a priori to reflect conditions unlikely to necessitate a CALE in evaluation of the MICCs themselves. All patients presenting to the ED during 1 week blocks (one week per month from 4/03-9/03) were screened for inclusion MICCs and evaluated. Using a standardized chart extraction tool, blinded assistants reviewed charts for documentation of 1) CALEs; 2) Abnormal CALE findings; and 3) Additional work-up or testing related to abnormal CALE findings.
Results: 297 patients met study inclusion/exclusion criteria; 63% were male, 50% were African-American, and the mean age was 36.4 years. All patients were seen primarily by EM residents. Among chief complaints, 40% were musculoskeletal, 30% were dermatologic or wound-care related, 13% were ophthalmologic, and 11% were dental or ENT-related. Cardiac exams were performed on 71% with abnormalities noted in 5 (2.3%) of patients, including tachycardia (2), peripheral edema (2), and murmur (1). One EKG was performed due to tachycardia and the patient was discharged home. Lung exams were performed on 82% with abnormality noted in 1 (0.4%) of patients_slight wheezing; no bronchodilators given and no chest xray taken. Abdominal exams were performed on 46% with abnormalities noted in 2 (1.4%) of patients--a superficial abrasion and known ascites; neither prompted other investigation or therapy. Among the 591 total cardiac, lung and abdominal exams performed, 8 (1.4%; 95% CI 0.7 - 2.7) were abnormal and only 1 (0.1%; 95% CI 0 - 0.1) finding led to further testing; none led to intervention or change in therapy.
Conclusions: In ED patients with MICCs, abnormal CALE findings are unusual and rarely lead to further testing or change in management. The practice of routine CALEs for ED patients with MICCs is not supported and warrants further investigation in a randomized outcome based study.
