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January 6, 1999JAMA

Abdominal palpation has moderate sensitivity for detecting AAA, ranging from 29% for 3.0-3.9 cm to 76% for ≥5.0 cm (P<.001), but cannot be relied on to exclude AAA.

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Why the study?

Does abdominal palpation accurately detect abdominal aortic aneurysm in patients not previously known to have AAA?

Population

Patients not previously known to have abdominal aortic aneurysm who were screened with both abdominal…

Comparison

Abdominal palpation to detect abnormal widening… vs Ultrasound (reference standard)

Design

Meta-analysis

Key result

Abdominal palpation has moderate sensitivity for detecting AAA, ranging from 29% for 3.0-3.9 cm to 76% for ≥5.0 cm (P<.001), but cannot be relied on to exclude AAA.

Authors

FLFrank A. Lederle

Discussion

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Overview

Abdominal palpation cannot exclude AAA; confirms imaging necessity and strengthens guideline caution against physical exam reliance.

Study Design

Type

Meta-Analysis

Structured PICO

Does abdominal palpation accurately detect abdominal aortic aneurysm in patients not previously known to have AAA?

P
Population
Patients not previously known to have AAA from 15 pooled studies who were screened with both abdominal palpation and ultrasound.
E
Exposure
Abdominal palpation to detect abnormal widening of the aortic pulsation
C
Comparator
Ultrasound (reference standard)
O
Outcome
Diagnostic accuracy (sensitivity, positive and negative likelihood ratios, positive predictive value) of abdominal palpation for detecting AAA

Main Result

Effect estimate: Positive LR 12.0 (95% CI 7.4-19.5)

p-value: p=<.001

Abdominal palpation has moderate sensitivity for detecting large AAAs but cannot reliably exclude AAA, especially if rupture is suspected.

Limitations

  • Abdominal obesity decreases the sensitivity of palpation
  • Cannot be relied on to exclude AAA, especially if rupture is a possibility
  • Limited data suggest that abdominal obesity decreases the sensitivity of palpation

Cite This Study

Frank A. Lederle (1999) conducted a meta-analysis in Abdominal aortic aneurysm (AAA). Abdominal palpation vs. Ultrasound was evaluated on Sensitivity and likelihood ratios of abdominal palpation for detecting AAA (Positive LR 12.0, 95% CI 7.4-19.5, p=<.001). Abdominal palpation has moderate sensitivity for detecting AAA, ranging from 29% for 3.0-3.9 cm to 76% for ≥5.0 cm (P<.001), but cannot be relied on to exclude AAA.

synapsesocial.com/papers/6a21e4c36b04332e556cab3bhttps://doi.org/10.1001/jama.281.1.77
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