![]() Additionally, there is a significant variability in agreement between examiners, with kappa generally below 0.5, which raises doubts regarding the reliability of the information for clinical application. For other findings not related to auscultation, the results seem inferior in relation to sensitivity. There is currently a greater emphasis on auscultation of the chest and some studies show that its performance is in fact more sensitive. Within the context of the past, this potentially allowed to increase the sensitivity and predictive value of disease assessment above the result of each separate test, which was appropriate in the absence of additional tests. This scenario considers the four domains of physical examination as multiple diagnostic tests and designed for interpretation as tests in parallel, considering that an abnormality anywhere is an indication of disease. Regarding the respiratory system, the examination routine is still taught in universities in a very similar way to what was done more than a century ago. In the USA, it was estimated that in 2016 there were 883.7 million outpatient consultations. In Brazil, in 2019 DATASUS registered 201.7 million outpatient medical consultations in primary and specialized care by the public health system and in 2018 the National Agency for Supplementary Health recorded 274.3 million consultations among beneficiaries of private health plans, which totals almost 500 million consultations every year. However, the growing appearance of complementary technologies, new understandings on the valuation of clinical findings in the management of patients and new models of doctor-patient relationship have led to a simplification of the physical examination and a consequent reduction in the time of care for patients. Despite the widespread acceptance that anamnesis provides the greatest contribution to diagnosis, some evidence has suggested that physical examination can add major elements to diagnosis in 8.7% to 17% of cases, which resulted in establishing detailed routines to offer a comprehensive examination. Until the middle of the last century, the clinical examination was practically the only basis for the diagnosis and treatment of patients and subsequent studies showed that the combination of anamnesis and physical examination could lead to diagnosis in up to 88% of cases, according to the understanding at that time. Conclusions: Auscultation of the chest alone, may not be a sufficient strategy to track diseases or establish whether continuity of the examination is necessary or not. The agreement between the examiners considering normal versus abnormal findings showed kappa = 0.76 for any changes in the physical examination present (p < 0.0001). A normal auscultation showed low accuracy to identify healthy individuals, with sensitivity, specificity, NPV and PPV, respectively, of 44%, 43%, 41% and 46%. An abnormal pulmonary auscultation had a sensitivity of 85.2%, positive predictive value (PPV) of 84.1%, positive likelihood reason (LR) of 1.53 (95% CI 1.16 to 2.01) and negative LR of 0.33 (95% CI 0.2 to 0.56) to identify the presence of any disease, and also a positive LR of 2.23 (95% CI 1.02 to 4.9) and a negative LR of 0.3 (95% CI 0.17 to 0.51) to predict additional abnormalities. ![]() Results: 192 physical examinations were performed in 104 patients. ![]() Methods: Patients with COPD, atelectasis, pleural effusion, pneumonia and controls were evaluated by two examiners in the absence of any clinical information, initially only with pulmonary auscultation, and then in the other domains of chest examination. The aim of the study was to evaluate the performance of auscultation of the chest for screening of disease and for predicting the presence of abnormalities in the other domains of the chest examination. Objective: The clinical examination is the basis for the diagnosis and rational choice of complementary tests.
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