Document Detail

Diagnosing allergic rhinitis: effectiveness of the physical examination in comparison to conventional skin testing.
MedLine Citation:
PMID:  22420396     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate the effectiveness of physical examination alone in diagnosing nasal allergic patients.
DESIGN: A cross-sectional study of 15 consecutive evaluable patients.
SETTING: A tertiary care otolaryngology clinic at the Jewish General Hospital, McGill University, Montreal.
METHODS: All patients were assessed by three physicians in random order. Each conducted a specific examination, made a clinical impression, and then took a directed history to make a second impression. Both impressions were compared to skin testing. Multivariate regression analyses assessed the linear relationships of both examination and history variables to impressions and skin testing results. Fleiss kappa tests assessed interrater reliabilities.
MAIN OUTCOME MEASURES: Accuracy in diagnosing allergic rhinitis by examination alone and inter-rater reliability in this diagnosis.
RESULTS: When comparing physical examination variables to history variables relative to the second impression, history variables had a stronger relationship (R²  =  .90 vs .52). This was also true when comparing both sets of variables to skin testing (R²  =  .81 vs .60). The interrater reliability of physical examination variables was poorer than that of the history variables (.377 and .494, respectively). Taking all physicians, the average sensitivity, specificity, positive predictive value, and negative predictive value of the history impression were all higher than those of the examination impression.
CONCLUSION: Physical examination alone yields unreliable and inconsistent results in diagnosing allergic rhinitis. This is likely secondary to the relative subjectivity involved in evaluating the nasal cavity. Adding a history to the examination is essential to increase diagnostic accuracy.
S Naweed Raza; Kashif Yousuf; Peter Small; Saul Frenkiel
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale     Volume:  40     ISSN:  1916-0216     ISO Abbreviation:  J Otolaryngol Head Neck Surg     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2012-03-16     Completed Date:  2012-09-14     Revised Date:  2013-04-10    
Medline Journal Info:
Nlm Unique ID:  101479544     Medline TA:  J Otolaryngol Head Neck Surg     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  407-12     Citation Subset:  IM    
Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, QC.
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MeSH Terms
Allergens / diagnostic use*
Cooperative Behavior
Cross-Sectional Studies
Interdisciplinary Communication
Middle Aged
Observer Variation
Physical Examination*
Rhinitis, Allergic, Perennial / diagnosis*
Rhinitis, Allergic, Seasonal / diagnosis*
Sensitivity and Specificity
Skin Tests*
Young Adult
Reg. No./Substance:

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