Document Detail

The accuracy of patient history, wheezing, and laryngeal measurements in diagnosing obstructive airway disease. CARE-COAD1 Group. Clinical Assessment of the Reliability of the Examination-Chronic Obstructive Airways Disease.
MedLine Citation:
PMID:  10770147     Owner:  NLM     Status:  MEDLINE    
CONTEXT: The accuracy of the clinical examination in detecting obstructive airway disease (OAD) is largely unknown because of a paucity of methodologically rigorous studies.
OBJECTIVE: To determine the accuracy of patient history, wheezing, laryngeal height, and laryngeal descent in the diagnosis of OAD.
DESIGN: Comparison study conducted from November 3, 1998, to December 4, 1998, evaluating 4 clinical examination elements for diagnosis of OAD vs the gold standard of forced expiratory volume in 1 second (FEV1) and FEV1-forced vital capacity (FVC) ratio less than the fifth percentile (adjusted for patient height, age, and sex).
SETTING: Twenty-five sites, including primary care and referral practices, in 14 countries.
PARTICIPANTS: A total of 309 consecutive patients were recruited (mean age, 56 years; 43% female), 76 (25%) with known chronic OAD, 114 (37%) with suspected chronic OAD, and 119 (39%) with neither known nor suspected OAD.
MAIN OUTCOME MEASURES: Sensitivity, specificity, and likelihood ratios (LRs) for each of the 4 elements of the clinical examination compared with the gold standard.
RESULTS: Mean FEV1 and FVC values were 2.1 L/s and 2.9 L; 52% had an FEV1 and FEV1-FVC ratio less than the fifth percentile. The LR for wheezing was 2.7 (95% confidence interval [CI], 1.7-4.2) and was not statistically significant in the multivariate model. The LR for laryngeal descent ranged from 0.9 (95% CI, 0.5-1.4) to 1.2 (95% CI, 0.4-3.4), depending on the cut point chosen, and did not enter the multivariate model. Only 4 of the history or physical examination elements we tested were significantly associated with the diagnosis of OAD on multivariate analysis: smoking for more than 40 pack-years (LR, 8.3), self-reported history of chronic OAD (LR, 7.3), maximum laryngeal height of 4 cm [corrected] or less (LR, 2.8), and age at least 45 years (LR, 1.3). Patients having all 4 findings had an LR of 220 (ruling in OAD); those with none had an LR of 0.13 (ruling out OAD). The area under the receiver operating characteristic curve for the model incorporating these 4 factors was 0.86.
CONCLUSIONS: Further research is needed to validate our model, but in the meantime, our data suggest that less emphasis should be placed on the presence of individual symptoms or signs (such as wheezing or laryngeal descent) in the diagnosis of OAD.
S E Straus; F A McAlister; D L Sackett; J J Deeks
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA     Volume:  283     ISSN:  0098-7484     ISO Abbreviation:  JAMA     Publication Date:  2000 Apr 
Date Detail:
Created Date:  2000-04-27     Completed Date:  2000-04-27     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1853-7     Citation Subset:  AIM; IM    
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MeSH Terms
Forced Expiratory Volume
Larynx / pathology,  physiopathology
Lung Diseases, Obstructive / diagnosis*,  physiopathology
Middle Aged
Multivariate Analysis
Patient Selection
Physical Examination*
ROC Curve
Respiratory Sounds
Sensitivity and Specificity
Vital Capacity
Comment In:
ACP J Club. 2001 Jan-Feb;134(1):29
Erratum In:
JAMA 2000 Jul 12;284(2):181

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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