| Toward a more efficient and effective neurologic examination for the 21st century. | |
| | |
MedLine Citation:
|
PMID: 16324094 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Practice pressures and quality improvement require greater efficiency and effectiveness in the neurologic examination. I hypothesized that certain 'marginal' elements of the examination rarely add value and that 'core' elements, exemplified by the plantar response (Babinski), are too often poorly performed or interpreted. I analyzed 100 published, neurologic clinicopathologic conferences (CPCs) and 180 ambulatory neurologic consultations regarding 13 hypothetically 'marginal' examination components (including 'frontal' reflexes, olfaction, jaw strength, corneal reflex, etc.); also, 120 exams on medical inpatients with neurologic problems, recording definitive errors. I surveyed the recalled practices of 24 non-neurologists and reviewed the literature for relevant data or guidance. In the CPCs the 'marginal' elements of the examination were rarely provided, requested, or used diagnostically, nor did they contribute in the 180 ambulatory consultations. In the chart review errors and omissions dominated testing of plantar responses, with missed Babinski signs in 14% of all cases and 77% of patients with Babinski signs. House officers harbored unrealistic expectations for performance of 'marginal' examination elements. Most textbooks omit detailed guidance (and none cite evidence) on achieving greater efficiency. Exams should be streamlined, while improving 'core' skills. Neurologists should apply evidence to update the exam taught to students and non-neurologists. |
| | |
Authors:
|
T H Glick |
Related Documents
:
|
16987184 - Assessing the mini-clinical evaluation exercise in comparison to a national specialty e... 17475104 - Medical myth: bimanual pelvic examination is a reliable decision aid in the investigati... 12584104 - Objectivity in objective structured clinical examinations: checklists are no substitute... 12674944 - Bullying and harassment in perioperative settings. 19128584 - Deafness associated with acetaminophen and codeine abuse. 11248584 - Concordance of stroke symptom onset time. the second delay in accessing stroke healthca... |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: European journal of neurology : the official journal of the European Federation of Neurological Societies Volume: 12 ISSN: 1351-5101 ISO Abbreviation: Eur. J. Neurol. Publication Date: 2005 Dec |
Date Detail:
|
Created Date: 2005-12-05 Completed Date: 2006-01-18 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 9506311 Medline TA: Eur J Neurol Country: England |
Other Details:
|
Languages: eng Pagination: 994-7 Citation Subset: IM |
Affiliation:
|
The Department of Neurology, Harvard Medical School, Boston, MA, USA. thomas_glick@hms.harvard.edu |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Humans Nervous System Diseases / diagnosis* Neurologic Examination / standards*, statistics & numerical data* Neurology / standards* Retrospective Studies |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: A role of TNF-alpha gene variant on juvenile ischemic stroke: a case-control study.
Next Document: Creutzfeldt-Jakob disease risk and PRNP codon 129 polymorphism: necessity to revalue current data.