78 ch071 633 670 9780323754835

Appendix
Chapter 71
Appendix: Likelihood Ratios, Confidence Intervals, and Pretest Probability
The following Table displays the point estimates and 95% confidence intervals for all of the
likelihood ratios (LRs) presented in this book. Also, the Table presents the range of disease
prevalences observed in the studies used to calculate the LRs (i.e., pretest probability of disease,
see Chapter 2). Chapter 3 presents the methods used to obtain the point estimates of LRs and
their confidence intervals, and individual chapters define each physical finding and further
discuss its significance.
Appendix Table 1 Likelihood Ratios, Confidence Intervals, and Pretest Probability

Finding Positive Negative Pre-test
LR (95% LR (95% Probability
CI) CI) (Range)
EBM Box 6.1 Dementia and delirium
Abnormal clock drawing test 4 (2.7, 5.9) 0.5 (0.4, 22–73
0.6)
Mini-Cog score 2 or less 4.5 (2.7, 0.1 (0.1, 3–52
7.4) 0.3)
Mini-mental status 23 or less 7.8 (6, 0.2 (0.2, 4–77
10.2) 0.3)
Mini-mental status 20 or less 14.4 (8, … 9–35
26.1)
Mini-mental status 21–25 2.1 (1.7, … 14–35
2.6)
Mini-mental status 26 or more 0.1 (0.1, … 14–77
0.2)
Confusion assessment method 11.5 (7.2, 0.2 (0.1, 14–64
18.4) 0.3)
Chapter 7 Stance and gait
Positive Trendelenburg sign and gait, detecting 3.2 (1.1, 0.4 (0.1, 1) 46
gluteus medius tear 9.1)
Hip abductor weakness, detecting lumbosacral 24 (3.5, 0.1 (0.1, 43
radiculopathy if foot drop 165.8) 0.4)
Asymmetric arm swing, detecting focal cerebral 2.1 (0.5, 0.9 (0.7,1.1) 71
CI) CI) (Range)
lesion 8.6)
Inability to tandem walk, detecting Parkinson- 4.9 (2, 0.2 (0.1, 37–72
plus disorder if parkinsonism 11.9) 0.3)
Positive Romberg test, detecting spinal stenosis 4.3 (1.6, 0.7 (0.5, 48
11.8) 0.9)
Prior fall in last year, predicting future fall 2.4 (2, 2.9) 0.6 (0.4, 19–53
0.9)
Timed-up-and-go test >16 s, detecting Parkinson- 5.6 (1.5, 0.4 (0.2, 72
plus disorder 21) 0.6)
Timed-up-and-go test >16 s, detecting Parkinson 0.2 (0, 0.7) 2.6 (1.7, 4) 28
disease
EBM BOX 7.1 Gait abnormalities
Able to tandem walk, detecting Parkinson disease 4.6 (3.1, 0.2 (0.1, 28–63
if parkinsonism 6.8) 0.5)
Any gait or balance disorder, detecting 0.2 (0.1, 3.4 (1.9, 75
Alzheimer dementia 0.3) 5.8)
Parkinsonian gait, detecting Lewy body dementia 8.8 (4.3, 0.2 (0.2, 50
or Parkinson disease with dementia 18.1) 0.4)
Frontal gait, detecting vascular dementia 6.1 (3.2, 0.5 (0.3, 25
11.3) 0.7)
EBM Box 7.2 Predicting falls

CI) CI) (Range)
Palmomental reflex present 2.8 (1.7, 0.8 (0.7, 32
4.4) 0.9)
Failure to stand with feet together and eyes open 4.5 (2.1, 1 (0.9, 1) 19
for 10 seconds 9.8)
Failure in tandem walk (>2 errors) 1.7 (1.5, 2) 0.7 (0.6, 19
0.8)
Stops walking when talking 3 (1.3, 6.8) 0.8 (0.7, 1) 36–48
Timed up and go <15 sec 0.1 (0, 0.3) … 53
Timed up and go 15–35 sec 1.1 (0.9, … 53
1.4)
Timed up and go ≥35 sec 2.6 (1.4, … 53
4.7)
Chapter 8 Jaundice
Caput medusa, detecting varices 1.5 (0.1, 1 (0.9, 1.1) 58
15.7)
Spider angiomas, detecting varices 1.2 (0.9, 0.9 (0.8, 13–46
1.6) 1.1)
Jaundice, detecting varices 1.1 (0.5, 1 (0.8, 1.2) 13
2.4)
Hepatomegaly, detecting varices 0.5 (0.1, 1.1 (1, 1.3) 13

CI) CI) (Range)
1.9)
CI) CI) (Range)
Palpable spleen, detecting varices 1.4 (1, 1.8) 0.8 (0.6, 1) 13–46
Ascites, detecting varices 1.5 (1.2, 2) 0.7 (0.6, 13–58
0.8)
Encephalopathy, detecting varices 1.3 (1.1, 0.9 (0.8, 1) 13–58
1.6)
Dyspnea, detecting hepatopulmonary syndrome 3.3 (2.1, 0.5 (0.4, 14–37
5.1) 0.7)
Platypnea, detecting hepatopulmonary syndrome 10.6 (4.4, 0.4 (0.2, 26
25.8) 0.6)
Child class C cirrhosis, detecting 2.2 (1.2, 0.5 (0.3, 14–34
hepatopulmonary syndrome 4.1) 0.7)
EBM Box 8.1 Hepatocellular jaundice
Weight loss 0.8 (0.2, 1.3 (0.5, 65–67
3.2) 3.3)
Spider angiomas 4.7 (1, 0.6 (0.5, 65–67
22.4) 0.9)
Palmar erythema 9.8 (1.4, 0.5 (0.4, 67
67.6) 0.7)
Dilated abdominal veins 17.5 (1.1, 0.6 (0.5, 67
277) 0.8)
Ascites 4.4 (1.1, 0.6 (0.5, 67

CI) CI) (Range)
17.1) 0.8)
CI) CI) (Range)
Palpable spleen 2.9 (1.2, 0.7 (0.6, 65–67
6.8) 0.9)
Palpable gallbladder 0.04 (0, 1.4 (1.1, 67
0.7) 1.9)
Palpable liver 0.9 (0.8, 1.4 (0.6, 65–67
1.1) 3.4)
Liver tenderness 1.4 (0.8, 0.8 (0.7, 65–67
2.6) 1.1)
EBM Box 8.2 Cirrhosis
Spider angiomas 4.2 (2.3, 0.6 (0.5, 7–67
7.6) 0.7)
Palmar erythema 3.7 (1.4, 0.6 (0.4, 11–67
9.8) 0.9)
Gynecomastia 7 (5.2, 9.4) 0.6 (0.3, 11–16
1.1)
Reduction of body or pubic hair 8.8 (6.3, 0.6 (0.4, 1) 11–16
12.5)
Jaundice 3.8 (2, 7.2) 0.8 (0.8, 11–53
0.9)
Dilated abdominal wall veins 9.5 (1.8, 0.8 (0.6, 1) 11–55

CI) CI) (Range)
49.2)
CI) CI) (Range)
Hepatomegaly 2.3 (1.6, 0.6 (0.4, 7–67
3.3) 0.7)
Palpable liver in epigastrium 2.7 (1.9, 0.3 (0.1, 7–37
3.9) 0.9)
Liver edge firm to palpation 3.3 (2.2, 0.4 (0.3, 27–67
4.9) 0.4)
Splenomegaly 2.5 (1.6, 0.8 (0.7, 18–67
3.8) 0.9)
Ascites 6.6 (3.6, 0.8 (0.7, 16–55
12.1) 0.8)
Peripheral edema 3 (1.9, 4.8) 0.7 (0.6, 16–55
0.9)
Encephalopathy 8.8 (3.3, 0.9 (0.8, 1) 16–39
23.7)
EBM Box 8.3 Hepatopulmonary syndrome
Clubbing 4.3 (2.7, 0.6 (0.5, 14–37
6.7) 0.8)
Cyanosis 4.4 (2, 9.8) 0.7 (0.5, 19–51
0.8)
Palmar erythema 1.7 (1.01, 0.8 (0.5, 14–26

CI) CI) (Range)
2.8) 1.2)
CI) CI) (Range)
Spider angiomas 2.1 (1.4, 3) 0.4 (0.3, 14–34
0.7)
Ascites 1.1 (1, 1.2) 0.9 (0.7, 14–33
1.1)
Jaundice 1 (0.8, 1.5) 1 (0.8, 1.1) 26–33
EBM Box 8.4 Portal-pulmonary hypertension
Blood pressure ≥140/90 7.3 (2.5, 0.4 (0.2, 1) 15
21.6)
O2 sat <92% 2.4 (0.5, 0.8 (0.6, 15
10.1) 1.3)
Elevated neck veins 2 (0.2, 0.9 (0.7, 15
16.6) 1.2)
Right ventricular heave 8.8 (1.7, 0.7 (0.4, 15
44.7) 1.1)
Loud P2 17.6 (2.1, 0.6 (0.4, 15
149) 1.1)
Ascites, edema 1.2 (0.7, 0.7 (0.2, 15
1.9) 2.4)
Chapter 9 Cyanosis
Cyanosis, detecting hepatopulmonary syndrome 4.4 (2, 9.8) 0.7 (0.5, 19–51
CI) CI) (Range)
0.8)
CI) CI) (Range)
EBM Box 9.1 Cyanosis
Central cyanosis 7.4 (1.5, 0.2 (0.1, 9–12
36.8) 0.5)
EBM Box 10.1 Anemia
Pallor at any site 3.8 (2.7, 0.5 (0.4, 2–71
5.3) 0.6)
Facial pallor 3.8 (2.5, 0.6 (0.5, 39
5.8) 0.7)
Nailbed pallor 4.3 (1.4, 0.5 (0.4, 39–71
13.8) 0.7)
Palmar pallor 5.6 (1.1, 0.4 (0.4, 39–71
29.1) 0.5)
Palmar crease pallor 7.9 (1.8, 0.9 (0.9, 1) 39
35.3)
Conjunctival pallor 4.7 (1.9, 0.6 (0.4, 39–71
11.5) 0.9)
Tongue pallor 3.7 (2.5, 0.6 (0.5, 21
5.4) 0.7)
Conjunctival rim pallor present 16.7 (2.2, … 47
125)
Conjunctival rim pallor borderline 2.3 (1.5, … 47

CI) CI) (Range)
3.5)
CI) CI) (Range)
Conjunctival rim pallor absent 0.6 (0.5, … 47
0.8)
EBM Box 11.1 Hypovolemia
Dry axilla 3.8 (2.4, 0.5 (0.4, 23–52
6.2) 0.7)
Dry mucous membranes of mouth and nose 2.8 (1.8, 0.4 (0.2, 33–77
4.3) 0.7)
Dry tongue 3.6 (1.6, 0.4 (0.2, 47–79
7.9) 0.7)
Longitudinal furrows on tongue 2 (1, 4) 0.3 (0.1, 77
0.6)
Sunken eyes 3.7 (1.3, 0.6 (0.4, 52–79
11) 0.9)
Abnormal skin turgor 3.5 (2.7, 0.3 (0.3, 33
4.4) 0.4)
Confusion 10 (0.5, 0.5 (0.4, 33–77
223) 0.6)
Weakness 2.3 (0.6, 0.7 (0.5, 1) 78
8.6)
Speech unclear or rambling 3.1 (0.9, 0.5 (0.3, 80

CI) CI) (Range)
11.1) 0.8)
CI) CI) (Range)
Chapter 12 Malnutrition and weight loss
Alcoholism, detecting organic disease 4.5 (1.1, 0.8 (0.7, 1) 55
18.9)
Cigarette smoking, detecting organic cause 2.2 (1.1, 0.6 (0.4, 55
4.4) 0.9)
Prior psychiatric disease, detecting organic cause 0.2 (0.1, 1.8 (1.3, 55
0.5) 2.5)
Normal physical examination, detecting organic 0.4 (0.3, 20.3 (2.9, 55
cause 0.6) 143)
Underestimation, predicting organic cause 5.4 (2, 0.6 (0.5, 50
14.5) 0.8)
Overestimation, predicting nonorganic cause 3.6 (2, 6.5) 0.4 (0.2, 50
0.6)
EBM Box 12.1 Malnutrition and complications
Weight loss >10% 1.4 (1.1, 0.9 (0.9, 1) 13–51
1.8)
Low body weight 2 (1.4, 2.9) 0.9 (0.8, 1) 13–40
Upper arm muscle circumference <85% 2.5 (1.7, 0.8 (0.7, 13–40
predicted 3.6) 0.9)
Forearm muscle circumference <85% predicted 3.2 (2, 5.1) 0.8 (0.6, 14–40
CI) CI) (Range)
0.9)
CI) CI) (Range)
Reduced grip strength 2.6 (1.9, 0.4 (0.3, 13–59
3.4) 0.6)
Chapter 14 Cushing syndrome
Osteoporosis, detecting Cushing syndrome 8.6 (2.3, 0.5 (0.3, 25–69
32.6) 0.8)
Weight loss, detecting ectopic ACTH syndrome 20 (1.2, 0.5 (0.2, 24
341) 1.1)
Symptom duration <18 mo, detecting ectopic 15 (3.2, 0.1 (0, 1) 23
ACTH syndrome 71.4)
Male sex, detecting ectopic ACTH syndrome 2.9 (1.7, 0.7 (0.5, 5–24
4.8) 0.9)
EBM Box 14.1 Cushing syndrome
Hypertension 2.3 (1.5, 0.8 (0.6, 25–56
3.7) 0.9)
Moon facies 1.6 (1.1, 0.1 (0, 0.9) 58
2.5)
Dorsal cervical fat pad 2.3 (1.5, 0.6 (0.4, 7
3.6) 0.9)
Central obesity 3 (2, 4.4) 0.2 (0.1, 25–56
0.3)
Generalized obesity 0.1 (0, 0.2) 2.5 (2.1, 25

CI) CI) (Range)
3.1)
CI) CI) (Range)
BMI >30 kg/M2 0.6 (0.3, 3.1 (1.7, 7–58
1.3) 5.6)
Skin fold thickness <1.8 mm 115.6 (7, 0.2 (0.1, 17
1854) 0.6)
Plethora 2.7 (2.1, 0.3 (0.1, 25
3.5) 0.5)
Hirsutism, in women 1.4 (1.02, 0.8 (0.6, 1) 7–65
1.9)
Ecchymoses 4.5 (1.8, 0.6 (0.4, 25–58
11.3) 0.7)
Red or blue striae 1.7 (1.2, 0.8 (0.7, 1) 7–58
2.4)
Acne 1.2 (0.4, 0.9 (0.5, 25–58
4.1) 1.7)
Proximal muscle weakness 3.8 (1.1, 0.7 (0.4, 1) 7–58
12.5)
Edema 1.8 (1.1, 0.7 (0.6, 25–57
3.1) 0.9)
Chapter 15 Pulse rate and contour

CI) CI) (Range)
Heart rate ≤50/min, predicting mortality if severe 20.7 (17, 0.8 (0.8, 5
trauma 25.2) 0.9)
Heart rate ≤40/min in acute illness, predicting 39.1 (22.6, 0.9 (0.9, 5
hospital mortality 68) 0.9)
Pulsus paradoxus >12 mm Hg, detecting cardiac 5.9 (2.4, 0.03 (0, 0.2) 63
tamponade 14.3)
Oximetry paradoxus <1.2, detecting cardiac 0.05 (0, 2.1 (1.5, 26
tamponade 0.7) 2.7)
Carotid upstroke delayed, detecting severe aortic 3.5 (2.6, 0.4 (0.2, 5–69
stenosis 4.6) 0.7)
Hyperkinetic pulse in patients with mitral 14.2 (7.4, 0.3 (0.2, 35
stenosis, detecting additional valvular disease 27.2) 0.4)
EBM Box 15.1 Tachycardia
Heart rate >85/min, predicting postoperative 3.8 (2.6, 0.4 (0.2, 23
complications if lung cancer surgery 5.6) 0.6)
Heart rate >90/min, predicting hospital mortality 1.5 (1.4, 0.2 (0.1, 10
in trauma patients with hypotension 1.7) 0.5)
Heart rate >95 /min, predicting hospital mortality 2 (1.3, 3.3) 0.1 (0, 0.5) 60
in patients with septic shock

CI) CI) (Range)
Heart rate >100/min, predicting hospital 3 (2.4, 3.7) 0.9 (0.8, 2–10
mortality in patients with myocardial infarction 0.9)
Heart rate >100/min, predicting active UGI 4.9 (3.2, 0.3 (0.2, 27
hemorrhage 7.6) 0.5)
Heart rate >100/min, predicting postoperative 5.6 (3.4, 9) 0.5 (0.3, 7
complications if hernia surgery 0.8)
Heart rate >100/min, predicting complications in 6.8 (3.7, 0.2 (0, 1) 7
patients with gallstone pancreatitis 12.5)
Heart rate >110/min, predicting hospital 25.4 (1.6, 0.3 (0.2, 55
mortality in patients with pontine hemorrhage 395) 0.6)
Heart rate >125/min, predicting mortality in 2.6 (2.2, 0.9 (0.8, 1) 7–16
patients with pneumonia 3.1)
EBM Box 15.2 Pulsus paradoxus and asthma
Pulsus paradoxus >10 mm Hg, detecting severe 2.7 (1.7, 0.5 (0.4, 36–77
asthma 4.3) 0.7)
Pulsus paradoxus >20 mm Hg, detecting severe 8.2 (1.7, 0.8 (0.7, 36–67
asthma 40.3) 0.9)
Pulsus paradoxus >25 mm Hg, detecting severe 22.6 (1.4, 0.8 (0.8, 77
asthma 363) 0.9)
EBM Box 15.3 Pulses and hypovolemic shock
Carotid pulse present, detecting systolic blood 1.2 (0.9, 0.2 (0, 2.1) 70
CI) CI) (Range)
pressure ≥60 mm Hg 1.8)
Femoral pulse present, detecting systolic blood 2.9 (1.1, 0.1 (0, 0.5) 70
pressure ≥60 mm Hg 7.2)
Radial pulse present, detecting systolic blood 4.7 (0.7, 0.5 (0.3, 70
pressure ≥60 mm Hg 31.3) 0.9)
Chapter 16 Abnormalities of pulse rhythm
Rapid regular pounding in neck, detecting 7.7 (1.9, 0.6 (0.5, 22–71
atrioventricular nodal reentrant tachycardia 31.8) 0.9)
EBM Box 16.1 AV dissociation and ventricular tachycardia
Varying arterial pulse, detecting AV dissociation 2.1 (1, 4.4) 0.5 (0.3, 1) 55
of ventricular tachycardia
Intermittent cannon a waves in neck veins, 3.8 (1.8, 0.1 (0, 0.4) 55
detecting AV dissociation of ventricular 8.2)
tachycardia
Changing intensity S1, detecting AV dissociation 24.4 (1.5, 0.4 (0.3, 55
of ventricular tachycardia 385) 0.7)
EBM Box 16.2 Atrial fibrillation
Radial pulse not regular 6.4 (4, 10) 0.1 (0.1, 3–30
0.2)
Chaotic pulse 24.1 (15.2, 0.5 (0.4, 6

CI) CI) (Range)
38) 0.6)
CI) CI) (Range)
Chapter 17 Blood pressure
Blood pressure <90 mm Hg, detecting future 4.2 (3, 5.8) 0.9 (0.9, 8–12
adverse events if syncope 0.9)
Interarm blood pressure difference >20 mm Hg, 89.1 (12.3, 0.2 (0.1, 7
detecting subclavian stenosis 643) 0.8)
Mediastinal widening on CXR, detecting aortic 2 (1.2, 3.4) 0.3 (0.2, 45–51
dissection 0.4)
Systolic blood pressure <100 mm Hg, detecting 5 (1.8, 14) 0.9 (0.9, 1) 61
type a dissection
Murmur of aortic regurgitation, detecting type a 5 (2.6, 9.8) 0.6 (0.5, 43–91
dissection 0.8)
Pulse deficit, detecting type a dissection 1.9 (1.5, 0.9 (0.8, 43–91
2.3) 0.9)
Findings of aortic coarctation, detecting 242 (89.3, 0.2 (0.1, 2
coarctation 657) 0.4)
Proportional pulse pressure <0.25, detecting low 6.9 (3, 0.2 (0.1, 50–64
cardiac index 15.8) 0.6)
Pulse pressure ≥80 mm Hg, detecting moderate- 10.9 (1.5, 0.5 (0.2, 42
to-severe aortic regurgitation 77.1) 0.8)

CI) CI) (Range)
Positive tourniquet test, detecting dengue 6.8 (2.4, 0.6 (0.4, 41–89
infection 19.1) 0.7)
EBM Box 17.1 Hypotension and prognosis
Systolic blood pressure <90 mm Hg, predicting 3.1 (1.9, 0.5 (0.2, 21–37
mortality in intensive care patients 5.1) 1.3)
mortality in patients with bacteremia 5.7) 1.4)
mortality in patients with pneumonia 7.8) 0.9)
Systolic blood pressure <90 mm Hg, predicting 15.3 (13.3, 0.9 (0.9, 2
mortality in emergency department patients with 17.4) 0.9)
acute illness
Systolic blood pressure <80 mm Hg, predicting 15.5 (12.2, 0.7 (0.7, 18
mortality in patients with acute myocardial 20) 0.7)
infarction
Systolic blood pressure ≤90 mm Hg, detecting 4.7 (3.4, 0.7 (0.7, 49
adverse outcomes in hospitalized patients 6.5) 0.8)
Systolic blood pressure ≤85 mm Hg, detecting 9 (5.3, 0.8 (0.7, 49

CI) CI) (Range)
Systolic blood pressure ≤80 mm Hg, detecting 16.7 (7.6, 0.8 (0.8, 49
EBM Box 17.2 Aortic dissection
Pulse deficit 4.3 (2.4, 0.8 (0.7, 13–76
7.6) 0.9)
Aortic regurgitation murmur 1.6 (1.02, 1 (0.9, 1) 23–76
2.5)
Focal neurologic signs 13.8 (1.3, 0.9 (0.8, 23–51
152) 0.9)
Systolic blood pressure <90 mm Hg 5.6 (3.8, 0.9 (0.8, 1) 23
8.3)
0 predictors 0.1 (0, 0.2) … 51
1 predictor 0.5 (0.4, … 51
0.8)
2 predictors 5.3 (3, 9.4) … 51
3 predictors 65.8 (4.1, … 51
1062)
EBM Box 17.3 Systolic blood pressure and impaired consciousness

CI) CI) (Range)
Systolic blood pressure ≥160 mm Hg in patients 7.3 (3.6, 0.6 (0.4, 46–59
with impaired consciousness, detecting structural 14.6) 0.8)
brain lesions
Chapter 18 Temperature
WBC >15,000, detecting bacteremia 1.6 (1.2, 0.8 (0.8, 9–37
2.2) 0.9)
Band count >1,500, detecting bacteremia 2.6 (1.3, 0.7 (0.6, 8–19
5.1) 0.9)
Low food consumption, detecting bacteremia 1.9 (1.4, 0.3 (0.2, 9–12
2.7) 0.5)
High food consumption, detecting bacteremia 0.2 (0.1, 1.5 (1.3, 9–12
0.3) 1.8)
Chills, detecting bacteremia 2 (1.8, 2.3) 0.7 (0.6, 7–37
0.8)
Shaking chills, detecting bacteremia 4.1 (3.2, 0.5 (0.3, 8–15
5.2) 0.8)
Stepladder pattern of fever, detecting enteric 177 (11, 0.5 (0.4, 38
fever 2842) 0.6)
Pulse ≤90/min, detecting dengue infection 3.3 (1.8, 0.4 (0.3, 50
5.9) 0.6)
Pulse ≤80/min, detecting dengue infection 5.3 (1.7, 0.7 (0.6, 50

CI) CI) (Range)
17.2) 0.9)
CI) CI) (Range)
Relative bradycardia, detecting enteric fever 1.7 (1.4, 0.3 (0.1, 25
2.1) 0.6)
Splenomegaly in FUO, predicting diagnostic 2.9 (1.9, 0.7 (0.5, 24–45
bone marrow examination 4.4) 0.8)
Lymphadenopathy in FUO, predicting diagnostic 1.9 (1.1, 0.9 (0.8, 1) 24–45
bone marrow examination 3.2)
EBM Box 18.1 Temperature, detecting infection
Rectal temperature >37.8°C 6.1 (3.9, 0.6 (0.5, 25
9.6) 0.7)
Forehead temperature >37.9°C 4.2 (2.8, 0.7 (0.6, 25
6.5) 0.8)
Tympanic temperature >37.5°C 8.5 (4.7, 0.7 (0.6, 25
15.4) 0.8)
EBM Box 18.2 Detection of fever
Patient’s report of fever 5.3 (1.4, 0.2 (0.1, 6–45
19.2) 0.5)
Patient’s forehead abnormally warm 2.8 (2.4, 0.3 (0.2, 24–49
3.3) 0.5)
EBM Box 18.3 Detection of bacteremia
Age 50 years or more 1.4 (1.2, 0.3 (0.1, 16–19

CI) CI) (Range)
1.6) 0.8)
CI) CI) (Range)
Renal failure 4.6 (2.6, 0.8 (0.7, 14–21
8.1) 0.9)
Hospitalization for trauma 3 (2.4, 3.8) 0.7 (0.3, 16–18
1.3)
Intravenous drug use 1.8 (0.8, 1.0 (1.0, 7
4.1) 1.0)
Previous stroke 1.5 (0.5, 1 (0.8, 1.1) 16–21
4.4)
Diabetes mellitus 1.4 (1.2, 0.9 (0.9, 1) 6–37
1.7)
Poor functional performance 3.6 (2.2, 0.6 (0.4, 14–21
5.9) 0.8)
Rapidly fatal disease (<1 mo) 2.7 (1.4, 0.9 (0.9, 1) 7–19
5.2)
Indwelling urinary catheter present 2.7 (1.7, 1 (0.9, 1) 7–37
4.3)
Central intravenous line present 2.4 (1.7, 0.9 (0.9, 7–32
3.4) 0.9)
Temperature ≥38.5 °C 1.2 (1.1, 0.7 (0.6, 8–19
1.4) 0.9)
Tachycardia 1.2 (1.2, 0.8 (0.7, 9–37

CI) CI) (Range)
1.3) 0.9)
CI) CI) (Range)
Respiratory rate >20/min 1 (0.9, 1.2) 0.9 (0.8, 14–37
1.1)
Hypotension 2.3 (1.9, 0.9 (0.8, 7–37
2.9) 0.9)
Acute abdomen 1.9 (1.5, 0.9 (0.9, 1) 7–32
2.3)
Confusion or depressed sensorium 1.5 (1.3, 0.9 (0.9, 1) 8–37
1.7)
EBM Box 18.4 Extremes of temperature
Hyperthermia, predicting death if pontine 23.7 (1.5, 0.4 (0.2, 55
hemorrhage 371) 0.6)
Hypothermia, predicting death if congestive heart 5.3 (2.7, 0.8 (0.7, 1) 5–6
failure 10.3)
Hypothermia, predicting death if pneumonia 3.5 (1.1, 0.8 (0.5, 4–9
10.9) 1.2)
Hypothermia, predicting death if sepsis 3.6 (2.5, 0.9 (0.9, 1) 10–43
5.1)
Chapter 19 Respiratory rate and patterns
Portal venous gas on CT, detecting bowel 3.2 (1.9, 0.8 (0.7, 51–52
ischemia 5.4) 0.9)
Dilated bowel on CT, detecting bowel ischemia 1.3 (1.1, 0.6 (0.5, 51–52
CI) CI) (Range)
1.6) 0.8)
CI) CI) (Range)
Pneumoperitoneum on CT, detecting bowel 1.4 (0.6, 0.9 (0.8, 52
ischemia 3.4) 1.1)
Respirations ≤12/min if altered mental status, 15.5 (9.6, 0.2 (0.1, 6
predicting response to naloxone 25.1) 0.5)
Kussmaul respirations, detecting severe 5.3 (3.2, 0.6 (0.5, 3–51
metabolic acidosis in patients with malaria 8.6) 0.7)
Asynchronous breathing, predicting need for 3.2 (1.3, 0.5 (0.2, 1) 31
intubation or hospital mortality in hospitalized 7.8)
patients with COPD
Paradoxical abdominal movements, detecting 3.2 (1.7, 0.1 (0, 1.1) 27
diaphragmatic weakness 5.9)
Orthopnea, detecting ejection fraction <50% 2.7 (1.5, 0.04 (0, 0.7) 46
4.9)
Platypnea, detecting hepatopulmonary syndrome 10.6 (4.4, 0.4 (0.2, 26
25.8) 0.6)
Bendopnea test, detecting pulmonary capillary 3.2 (1.6, 0.6 (0.5, 45
wedge pressure ≥22 mm Hg 8.5) 0.8)
EBM Box 19.1 Tachypnea
Respirations >20/min, predicting ischemic bowel 5.9 (1.6, 0.8 (0.7, 51–52
or obstruction if pneumatosis 20.9) 0.8)
Respirations >24/min, predicting failure of 2.9 (1.2, 0.1 (0, 1.4) 41

CI) CI) (Range)
weaning from mechanical ventilation 7.1)
Respirations >27/min, predicting 4.3 (2.1, 0.7 (0.5, 20–39
cardiopulmonary arrest, in medical inpatients 8.6) 0.9)
Respirations >28/min, detecting pneumonia in 2.7 (1.4, 0.9 (0.8, 9–38
outpatients with cough and fever 5.1) 0.9)
Respirations >30/min, predicting hospital 2.4 (2.1, 0.9 (0.8, 2–17
mortality in patients with pneumonia 2.8) 0.9)
EBM Box 19.2 Cheyne-Stokes respirations
Cheyne-Stokes respirations, detecting EF <40% 5.4 (3.2, 0.7 (0.6, 20
(all patients) 9.2) 0.8)
Cheyne-Stokes respirations, detecting EF <40% 8.1 (4, 0.7 (0.6, 21
(≤80 years old) 16.3) 0.8)
Cheyne-Stokes respirations, detecting EF <40% 2.7 (1.1, 0.7 (0.4, 17
(>80 years old) 6.6) 1.1)
EBM Box 20.1 Pulse oximetry
O2 sat <90%, predicting hospital mortality 4.5 (1.9, 0.8 (0.7, 6–15
10.5) 0.9)
O2 sat <96%, detecting hepatopulmonary 4.3 (2.2, 0.7 (0.6, 32–36
syndrome in patients with chronic liver disease 8.7) 0.9)

CI) CI) (Range)
O2 sat <95%, detecting pneumonia in outpatients 3 (2.2, 4.2) 0.7 (0.6, 11–51
with cough and fever 0.8)
Chapter 21 The pupils
Marcus Gunn pupil, detecting abnormal retinal 4.2 (2.2, 0.1 (0, 0.7) 27
fiber layer in glaucoma 7.8)
Marcus Gunn pupil, detecting abnormal retinal 3.6 (2.1, 6) 0.6 (0.4, 9
fiber layer in multiple sclerosis 0.9)
Positive swinging flashlight test, detecting 4.8 (2.2, 0.3 (0.1, 5
pathologic cup-to-disc ratio 10.4) 1.6)
Marcus Gunn pupil, detecting optic nerve or 16.8 (4.2, 0.3 (0.1, 23
retinal disease if unilateral visual loss 67.8) 0.7)
Marcus Gunn pupil, detecting macular or media 0.1 (0, 0.2) 3.4 (1.5, 77
disease if unilateral visual loss 7.7)
Both pupils nonreactive to light, detecting 3.4 (1.5, 0.4 (0.4, 45–53
unfavorable outcome after craniotomy for 7.6) 0.5)
subdural hematoma
Pinpoint pupils, detecting response to naloxone if 8.5 (6.1, 0.1 (0, 0.4) 6
abnormal mental status (opiate intoxication) 11.9)
EBM Box 21.1 Pupils and anisocoria

CI) CI) (Range)
Anisocoria >1 mm, detecting intracranial 9 (2.8, 0.6 (0.5, 40
structural lesion in patients with coma 28.8) 0.8)
Absent light reflex in at least one eye, detecting 3.6 (2.3, 0.2 (0.1, 40
intracranial structural lesion in patients with 5.6) 0.4)
coma
Anisocoria and 3rd nerve palsy, detecting 3.2 (1.5, 0.7 (0.6, 48
intracranial hemorrhage in patients with stroke 7.1) 0.9)
Horner syndrome, detecting posterior circulation 72 (4.3, 1 (0.9, 1) 26
disease if stroke 1213)
Anisocoria or abnormal light reaction, detecting 2.4 (1.9, 0.2 (0.1, 17–38
intracranial aneurysm in patients with 3rd nerve 3.1) 0.4)
palsy
Anisocoria (≥1 mm difference) in red eye, with 6.5 (2.6, 0.8 (0.8, 47
smaller pupil in red eye, detecting serious disease 16.3) 0.9)
Anisocoria in red eye, with larger pupil in red 57.6 (3.6, 0.1 (0, 1.4) 11
eye, detecting acute angle closure glaucoma 915)
EBM Box 21.2 Horner syndrome, eyedrop tests
Post topical cocaine anisocoria >1 mm, detecting 96.8 (6.1, 0.1 (0, 0.1) 68
Horner syndrome 1527)

CI) CI) (Range)
Reversal of anisocoria after apraclonidine, 14 (2.1, 0.1 (0, 0.4) 50–69
detecting Horner syndrome 92.3)
Small pupil dilates with hydroxyamphetamine, 9.2 (2, 0.2 (0.1, 45–52
detecting 1st/2nd neuron lesion in patients with 43.6) 0.3)
Horner syndrome
Small pupil fails to dilate with topical 4.2 (1.3, 0.2 (0, 2.1) 21
phenylephrine, detecting 1st/2nd neuron lesion in 13.4)
patients with Horner syndrome
Asymmetric facial sweating, detecting 1st/2nd 2.4 (0.9, 0.6 (0.4, 63
neuron lesion in patients with Horner syndrome 6.1) 0.9)
Chapter 22 Diabetic retinopathy
Nonmydriatic imaging (>2 F), detecting diabetic 24.5 (7.0, 0.1 (0.1,
retinopathy 85.8) 0.2)
EBM Box 22.1 Diabetic retinopathy
Abnormal visual acuity 20/40 or worse 1.5 (1.3, 0.9 (0.9, 1) 2–24
1.7)
Direct ophthalmoscopy, nondilated pupils 6.2 (2.5, 0.5 (0.3, 21
14.9) 0.8)
Direct ophthalmoscopy, dilated pupils, general 9.4 (6.2, 0.4 (0.3, 5–15
providers 14.3) 0.5)
Direct ophthalmoscopy, dilated pupils, specialists 25.5 (8.2, 0.3 (0.2, 5–15
CI) CI) (Range)
79.1) 0.5)
CI) CI) (Range)
Chapter 23 The red eye
Matting of both eyes, detecting bacterial 2.6 (1.8, 0.7 (0.6, 36
conjunctivitis 3.7) 0.8)
Absence of eye matting, detecting bacterial 0.3 (0.2, 1.2 (1.1, 36
Itching, detecting bacterial conjunctivitis 0.9 (0.7, 1.1 (0.9, 36–40
1.1) 1.3)
Burning sensation, detecting bacterial 0.9 (0.5, 1.1 (0.9, 36–40
Report of “purulent” secretions, detecting 0.8 (0.3, 1.1 (0.7, 40
bacterial conjunctivitis 2.1) 1.6)
Clinical diagnosis bacterial conjunctivitis 5.3 (4.2, 0.2 (0.1, 43
6.8) 0.2)
Clinical diagnosis viral conjunctivitis 3.5 (2.8, 0.4 (0.3, 42
4.4) 0.5)
Clinical diagnosis allergic conjunctivitis 16.4 (11.8, 0.01 (0, 0.2) 8
23)
EBM Box 23.1 Serious eye disease
Direct photophobia 8.3 (2.7, 0.4 (0.3, 28–59
25.9) 0.5)
Indirect photophobia 28.8 (1.8, 0.6 (0.4, 59

CI) CI) (Range)
459) 0.7)
CI) CI) (Range)
Finger-to-nose convergence test 21.4 (12, 0.3 (0.1, 4
38.3) 0.6)
Anisocoria (smaller pupil in red eye), serious eye 6.5 (2.6, 0.8 (0.8, 47
disease 16.3) 0.9)
Anisocoria (larger pupil in red eye), acute 57.6 (3.6, 0.1 (0, 1.4) 11
glaucoma 915)
EBM Box 23.2 Bacterial conjunctivitis
Redness, periphery only 0.7 (0.5, 1) 1.2 (1, 1.4) 36
Redness observed at 20 feet 1.5 (1.1, 0.2 (0, 0.8) 42
1.9)
Redness obscures tarsal vessels completely 4.6 (1.2, 0.7 (0.5, 1) 42
17.1)
No discharge 0.4 (0.2, … 40–42
0.8)
Watery discharge 0.4 (0.2, … 40–42
1.2)
Mucous discharge 1.8 (0.9, … 40–42
3.8)
Purulent discharge 3.9 (1.7, 40–42
9.1)
Follicular conjunctivitis 1 (0.5, 1.7) 1 (0.6, 1.9) 40

CI) CI) (Range)

CI) CI) (Range)
Papillary conjunctivitis 4.4 (0.8, 0.8 (0.6, 40
25.5) 1.1)
Preauricular adenopathy 0.6 (0.1, 4) 1.1 (0.8, 40–42
1.6)
Chapter 24 Hearing
Patient’s perceptions of hearing difficulty 2.5 (0.9, 7) 0.4 (0.2, 34–73
0.6)
EBM Box 24.1 Hearing tests
Abnormal whispered voice test 6.7 (5, 8.9) 0.1 (0.1, 43–73
0.2)
Cannot hear strong finger rub 355 (22, 0.4 (0.3, 34
5685) 0.5)
Cannot hear faint finger rub 3.9 (3.2, 0.02 (0, 0.1) 34
4.8)
Cannot hear ticking watch 106 (6.6, 0.6 (0.5, 44
1696) 0.7)
Rinne test 27.6 (11.2, 0.3 (0.2, 4–72
68) 0.4)
Weber test lateralizes to good ear, detecting 2.5 (1.2, 0.8 (0.5, 30–77
neurosensory loss 5.6) 1.4)
Weber test lateralizes to bad ear, detecting 17.1 (0.9, 0.5 (0.3, 23–70
CI) CI) (Range)
conductive loss 333) 0.6)
Chapter 25 Thyroid disease
Half relaxation time >380 ms, detecting 18.7 (13.3, 0.1 (0, 0.2) 9–15
hypothyroidism 26)
EBM Box 25.1 Goiter
No goiter by palpation or inspection 0.4 (0.3, … 37–79
0.5)
Goiter by palpation, visible only after neck 0.9 (0.4, … 52
extension 2.1)
Goiter by palpation and inspection with neck in 26.3 (5.2, … 37–65
normal position 132)
EBM Box 25.2 Goiter and thyroid nodules, predicting carcinoma
Goiter, cervical adenopathy 15.4 (4.8, 0.6 (0.4, 32
49) 0.7)
Goiter, vocal cord paralysis 11.3 (2.2, 0.7 (0.6, 12–27
59.3) 0.9)
Goiter, fixation to tissues 10.5 (4.7, 0.4 (0.3, 32
23.5) 0.6)
Goiter nodular (vs diffuse) 1.5 (1.2, 0.4 (0.2, 31
1.9) 0.8)
Goiter, pyramidal lobe present 0.2 (0, 1.7) 1.1 (1, 1.2) 31
CI) CI) (Range)

CI) CI) (Range)
Thyroid nodule, vocal cord paralysis 17.9 (3.9, 0.9 (0.9, 1) 15–23
81.1)
Thyroid nodule, fixation to surrounding tissues 7.8 (3.3, 0.8 (0.6, 1) 23–46
18.3)
Thyroid nodule, cervical adenopathy 7.2 (4.3, 0.8 (0.7, 15–23
12) 0.9)
Thyroid nodule, ≥4 cm diameter 1.9 (1.4, 0.5 (0.4, 46
2.7) 0.7)
Thyroid nodule, very firm nodule 3.3 (0.2, 1 (0.9, 1) 23
52.1)
EBM Box 25.3 Hypothyroidism
Cool and dry skin 4.7 (3.1, 0.9 (0.8, 12
7.1) 0.9)
Coarse skin 3.4 (1.4, 8) 0.7 (0.5, 18
0.9)
Cold palms 1.6 (1, 2.7) 0.8 (0.6, 18
1.1)
Dry palms 1.5 (1, 2.4) 0.8 (0.6, 18
1.1)
Puffiness of face 1.7 (0.7, 0.6 (0.4, 18

CI) CI) (Range)
4.2) 0.8)
CI) CI) (Range)
Puffiness of wrists 2.9 (1.7, 0.7 (0.5, 18
4.9) 0.9)
Hair loss of eyebrows 1.9 (1.1, 0.8 (0.7, 1) 18
3.6)
Pretibial edema 1.1 (0.9, 0.7 (0.3, 18
1.5) 1.6)
Hypothyroid speech 5.4 (2.7, 0.7 (0.5, 18
10.7) 0.9)
Slow pulse rate 4.2 (3.2, 0.7 (0.7, 12–20
5.4) 0.8)
Enlarged thyroid 2.8 (2.3, 0.6 (0.6, 12
3.4) 0.7)
Delayed ankle reflex 3.4 (1.8, 0.6 (0.4, 18
6.4) 0.9)
Slow movements 1 (0.8, 1.2) 1 (0.3, 3.2) 18
Billewicz score <–15 points 0.1 (0, 0.2) … 30–37
Billewicz score –15 to +29 points 0.9 (0.4, … 30–37
2.1)
Billewicz score +30 points or more 18.8 (1.2, … 30–37
301)
EBM Box 25.4 Hyperthyroidism

CI) CI) (Range)
Pulse rate ≥90/min 4.5 (3.9, 0.2 (0.2, 50
5.2) 0.3)
Skin moist and warm 6.8 (5, 9.2) 0.7 (0.7, 50
0.7)
Thyroid enlargement 2.3 (2.1, 0.1 (0.1, 50
2.5) 0.2)
Eyelid retraction 33.2 (17.2, 0.7 (0.6, 50
64) 0.7)
Eyelid lag 18.6 (9.6, 0.8 (0.8, 50
36.1) 0.8)
Fine finger tremor 11.5 (8.8, 0.3 (0.3, 50
14.9) 0.4)
Wayne index <11 points 0.04 (0, … 32–43
0.3)
Wayne index 11 to 19 points 1.2 (0.7, 2) … 32–43
Wayne index ≥20 points 18.2 (2.9, … 32–43
114)
Chapter 26 Meninges
Nuchal rigidity, detecting CSF WBC >100/uL 1.5 (1.1, 0.9 (0.7, 1) 7–35
CI) CI) (Range)
1.9)
CI) CI) (Range)
Kernig sig, detecting CSF WBC >100/uL 2.5 (1.3, 0.9 (0.9, 1) 7–35
4.9)
Brudzinski sign, detecting CSF WBC >100/uL 2.2 (1.1, 0.9 (0.9, 1) 7–35
4.6)
Lack of focal neurologic findings, detecting 5.9 (3.5, 0.4 (0.2, 11
subarachnoid hemorrhage in stroke 9.9) 0.7)
EBM Box 26.1 Meningitis
Nuchal rigidity, detecting CSF WBC >5/uL 1.5 (1.2, 0.7 (0.6, 21–69
1.9) 0.9)
Kernig sig, detecting CSF WBC >5/uL 2.1 (1.02, 0.9 (0.8, 1) 21–69
4.3)
Brudzinski sign, detecting CSF WBC >5/uL 2.4 (1.5, 0.8 (0.7, 1) 21–69
3.8)
Jolt accentuation headache 1.8 (1.2, 0.7 (0.5, 20–69
2.7) 0.9)
EBM Box 26.2 Intracranial hemorrhage
Neck stiffness, detecting subarachnoid 6.7 (5.5, 0.7 (0.5, 6–46
hemorrhage, if sudden headache 8.2) 0.8)
Neck stiffness, detecting intracranial hemorrhage 5.4 (2.5, 0.7 (0.7, 18–59
if stroke 11.3) 0.9)
Chapter 27 Lymphadenopathy
CI) CI) (Range)
Generalized pruritus, detecting serious disease 4.9 (1.8, 0.9 (0.9, 1) 26
13.1)
Throat soreness, detecting serious disease 0.2 (0.1, 1.4 (1.2, 26–71
0.4) 1.6)
Posterior cervical adenopathy, detecting 3.1 (1.6, 0.7 (0.5, 1) 3
infectious mononucleosis 5.9)
Posterior auricular adenopathy, detecting 11 (4.8, 0.7 (0.5, 1) 2
infectious mononucleosis 25.3)
Axillary adenopathy, detecting infectious 3 (1.2, 7.1) 0.8 (0.6, 2
mononucleosis 1.1)
Inguinal adenopathy, detecting infectious 3 (1.8, 4.9) 0.6 (0.3, 1) 2
mononucleosis
Marked axillary adenopathy, detecting infectious 19.8 (5.7, 0.8 (0.6, 1) 2
mononucleosis 69.4)
Epitrochlear nodes >0.5 cm, detecting HIV 4.5 (3.1, 0.2 (0.1, 56
infection 6.7) 0.3)
Axillary adenopathy if tuberculosis, detecting 4.9 (2.2, 0.7 (0.5, 9–56
HIV infection 11.2) 0.9)

CI) CI) (Range)
Lymphadenopathy, indicating bone marrow 1.9 (1.1, 0.9 (0.8, 1) 24–45
examination diagnostic if FUO 3.2)
Axillary adenopathy, detecting metastases if 9.3 (2.3, 0.7 (0.7, 25–40
breast cancer 37.6) 0.8)
EBM Box 27.1 Lymphadenopathy
Male sex 1.3 (1.1, 0.8 (0.7, 26–60
1.6) 0.9)
Age ≥40 years 2.4 (1.7, 0.4 (0.3, 26–63
3.5) 0.6)
Weight loss 2.8 (1.7, 0.8 (0.8, 26–53
4.8) 0.9)
Fever 0.7 (0.5, 1.1 (1.1, 26–57
0.9) 1.2)
Head and neck nodes (not supraclavicular) 0.9 (0.8, 1.1 (1, 1.2) 14–70
1.03)
Supraclavicular nodes 2.9 (2.4, 0.8 (0.8, 14–70
3.6) 0.9)
Axillary nodes 0.8 (0.7, 1.1 (1, 1.1) 14–70
0.9)
Inguinal nodes 0.6 (0.4, 1.1 (1, 1.1) 14–70

CI) CI) (Range)
0.9)
CI) CI) (Range)
Epitrochlear nodes 0.7 (0.1, 1 (1, 1.1) 41
7.6)
Generalized lymphadenopathy 1.3 (0.8, 0.9 (0.8, 14–60
2.1) 1.1)
Node size <4 cm2 0.4 (0.3, … 26
0.7)
Node size 4–8.99 cm2 2 (0.4, 9.2) … 26
Node size ≥9 cm2 8.4 (2.1, … 26
32.8)
Hard texture 3.2 (2.4, 0.6 (0.4, 26
4.3) 0.7)
Lymph node tenderness 0.4 (0.3, 1.3 (1.1, 26–53
0.6) 1.5)
Fixed lymph node 10.9 (2, 0.7 (0.3, 26–53
59.2) 1.3)
Rash 0.6 (0.3, 1 (1, 1.1) 26–41
1.4)
Palpable spleen 1.2 (0.6, 1 (0.9, 1) 26–41
2.5)
Palpable liver 1.2 (0.7, 1 (0.9, 1.1) 26–41

CI) CI) (Range)
1.9)
CI) CI) (Range)
Score –3 or less 0.04 (0, … 24–26
0.2)
Score –2 or –1 0.1 (0, 0.3) … 24–26
Score 0 to 4 1.1 (0.5, … 24–26
2.3)
Score 5 or 6 5.1 (2.9, … 24–26
8.8)
Score 7 or more 21.9 (2.7, … 24–26
179)
Chapter 28 Inspection of the chest
Schamroth sign positive, detecting 8 (5.1, 0.2 (0.1, 38
interphalangeal ratio >1 12.5) 0.3)
EBM Box 28.1 Clubbing
Finger clubbing, detecting hypoxemia 3.2 (1.7, 0.1 (0.1, 75
6.1) 0.3)
Finger clubbing, detecting endocarditis 5.1 (2.9, 0.9 (0.9, 1) 20
9.2)
Finger clubbing, detecting hepatopulmonary 4.3 (2.7, 0.6 (0.5, 14–37
syndrome 6.7) 0.8)
EBM Box 28.2 Inspection of the chest
Barrel chest, detecting chronic obstructive 1.5 (1.2, 2) 0.6 (0.4, 49

CI) CI) (Range)
disease 0.8)
AP/L chest diameter ratio ≥0.9, detecting chronic 2 (1.1, 3.3) 0.8 (0.7, 1) 49
obstructive disease
Pursed-lip breathing, detecting chronic 2.7 (1.8, 4) 0.5 (0.4, 49
obstructive disease 0.7)
Scalene/sternomastoid muscle use, detecting 3.3 (1.8, 0.7 (0.6, 49
chronic obstructive disease 5.9) 0.8)
Accessory muscle use in patients with ALS 4.9 (0.4, 0.2 (0.1, 92
detecting respiratory neuromuscular weakness 61.7) 0.6)
Accessory muscle use, detecting pulmonary 1.5 (0.6, 0.9 (0.8, 21
embolism 3.6) 1.1)
Intercostal retractions, detecting acidosis 2.2 (1.5, 0.6 (0.4, 21
3.1) 0.8)
Suprasternal retractions, detecting acidosis 4 (2.1, 7.6) 0.7 (0.6, 21
0.9)
Nasal flaring, detecting acidosis 4.6 (2.9, 0.5 (0.3, 21
7.4) 0.7)
EBM Box 29.1 Palpation of the chest
Asymmetric chest expansion, detecting 44.1 (2.1, 1 (0.9, 1) 10
pneumonia 905)
Asymmetric chest expansion, detecting pleural 8.1 (5.2, 0.3 (0.2, 21

CI) CI) (Range)
effusion 12.7) 0.4)
Asymmetric chest expansion, detecting right 15.8 (5, 0.6 (0.4, 5–50
mainstem bronchus intubation 49.6) 0.8)
Diminished tactile fremitus, detecting pleural 5.7 (4, 8) 0.2 (0.1, 20
effusion 0.4)
Chest wall tenderness, detecting pneumonia 1.2 (0.3, 1 (0.9, 1.1) 16
5.3)
Chest wall tenderness, detecting pulmonary 0.8 (0.6, 1.1 (1, 1.1) 21–23
embolism 1.1)
Chest wall tenderness, detecting coronary artery 0.8 (0.7, 1.1 (1, 1.3) 44–62
disease 0.9)
Chest wall tenderness, detecting myocardial 0.3 (0.2, 1.2 (1.2, 12–21
infarction 0.5) 1.3)
EBM Box 29.2 Percussion of the chest
Percussion dullness, detecting pneumonia 3.6 (2.4, 0.9 (0.9, 1) 3–38
5.4)
Percussion dullness, detecting chest radiograph 3 (1.4, 6.3) 0.9 (0.9, 1) 26–46
abnormality
Percussion dullness, detecting pleural effusion 4.8 (3.6, 0.1 (0.1, 21
6.4) 0.3)
Hyperresonance upper right anterior chest, 7.3 (3.6, 0.8 (0.7, 16–40
CI) CI) (Range)
detecting chronic obstructive disease 14.9) 0.9)
Reduced diaphragm excursion, detecting chronic 5.3 (0.8, 0.9 (0.7, 16
airflow obstruction 35) 1.1)
Auscultatory percussion abnormal, detecting 1.7 (1, 3) 0.8 (0.6, 26–46
chest radiograph abnormality 1.1)
Auscultatory percussion abnormal, detecting 8.3 (1.8, 0.2 (0, 1.6) 21–40
pleural effusion 38.7)
Chapter 30 Auscultation of the Lungs
Any crackles, predicting 30 day mortality in 4.5 (3.9, 0.7 (0.6, 4
myocardial infarction 5.3) 0.8)
EBM Box 30.1 Breath sounds and vocal resonance
Breath sound score ≤9 10.2 (4.6, … 19–56
22.7)
Breath sound score 10–12 3.6 (1.4, … 19–56
9.5)
1.5)
Breath sound score ≥16 0.1 (0, 0.3) … 19–56
Diminished breath sounds, detecting obstructive 3.5 (2.1, 0.5 (0.4, 15–49
lung disease 5.6) 0.7)
Diminished or absent breath sounds, detecting 5.2 (3.8, 0.1 (0.1, 21

CI) CI) (Range)
pleural effusion in hospitalized patients 7.1) 0.3)
Diminished breath sounds, detecting underlying 3 (1.5, 6) 0.7 (0.6, 26–48
pleural effusion in mechanically ventilated 0.9)
patients
Diminished breath sounds, detecting asthma 4.2 (1.9, 0.3 (0.1, 50
during methacholine challenge 9.5) 0.6)
Diminished breath sounds, detecting pneumonia 2.4 (1.9, 3) 0.8 (0.8, 5–41
in patients with cough and fever 0.9)
Asymmetric breath sounds, detecting 12.8 (5.8, 0.5 (0.3, 5–62
endobronchial intubation 28.4) 0.8)
Bronchial breath sounds, detecting pneumonia in 3.3 (2.3, 0.9 (0.8, 14–20
patients with cough and fever 4.8) 0.9)
Egophony, detecting pneumonia in patients with 4.1 (2.1, 0.9 (0.9, 1) 3–38
cough and fever 7.8)
Reduced vocal fremitus, detecting pleural 6.5 (4.4, 0.3 (0.2, 20
effusion in hospitalized patients 9.6) 0.4)
EBM Box 30.2 Crackles
Crackles, detecting pulmonary fibrosis in 5.9 (2, 0.2 (0.1, 58
asbestos workers 17.2) 0.5)
Crackles, detecting “honeycombing” on CT 1.8 (1.5, 0.04 (0, 0.7) 18

CI) CI) (Range)
2.1)
CI) CI) (Range)
Crackles, detecting elevated left atrial pressure in 2.1 (1.2, 0.8 (0.7, 1) 54–86
patients with cardiomyopathy 3.8)
Crackles, detecting myocardial infarction in 2.1 (1.6, 0.8 (0.7, 1) 6–12
patients with chest pain 2.8)
Crackles, detecting pneumonia in patients with 2.8 (1.8, 0.8 (0.7, 3–41
cough and fever 4.4) 0.8)
Early inspiratory crackles, detecting airway 14.6 (3, 70) 0.4 (0.1, 15–55
obstruction in patients with crackles 1.4)
Early inspiratory crackles, detecting severe 20.8 (3, 0.1 (0, 0.4) 48
disease in patients with chronic airflow 142.2)
obstruction
EBM Box 30.3 Wheezes, rubs, and squawks
Unforced wheezing, detecting chronic airflow 2.6 (1.7, 0.8 (0.7, 13–83
obstruction 3.9) 0.9)
Wheezing, detecting pneumonia in patients with 0.8 (0.7, 1.1 (1, 1.1) 5–41
cough and fever 0.9)
Wheezing, detecting pulmonary embolism 0.4 (0.1, 1.1 (1, 1.2) 23–40
0.97)
Wheezing during methacholine challenge testing, 6 (1.5, 0.6 (0.4, 50
detecting asthma 24.3) 0.9)
Pleural rub, detecting pulmonary embolism 1.4 (0.6, 1 (1, 1) 21–23

CI) CI) (Range)
3.1)
CI) CI) (Range)
Pleural rub, detecting pleural effusion 3.9 (0.8, 1 (0.9, 1) 21
18.7)
Inspiratory squawk, detecting hypersensitivity 3.2 (1.9, 0.9 (0.9, 1) 22
pneumonitis 5.5)
EBM Box 31.1 Ancillary tests
Forced expiratory time 9 or more seconds, 3.9 (2.7, … 50–71
detecting chronic obstruction 5.7)
Forced expiratory time 3–9 seconds, detecting 1.1 (0.8, … 50–71
chronic obstruction 1.4)
Forced expiratory time <3 seconds, detecting 0.2 (0.1, … 50–71
chronic obstruction 0.3)
Unable to blow out the match, detecting FEV1 9.6 (5.5, 0.2 (0.1, 37–56
≤1.6 L 16.6) 0.8)
Chapter 32 Pneumonia
CRB-65 0, predicting mortality 0.3 (0.2, … 2–13
0.4)
0.8)
2.3)

CI) CI) (Range)
5.8)
CI) CI) (Range)
13.2)
EBM Box 32.1 Pneumonia
Cachexia 4 (1.7, 9.6) 0.9 (0.8, 1) 3
Abnormal mental status 1.9 (1.2, 3) 0.9 (0.9, 1) 14–38
Pulse >100/min 2.1 (1.8, 0.8 (0.7, 3–41
2.5) 0.8)
Temperature >37.8°C 2.5 (2, 3.1) 0.7 (0.6, 3–51
0.8)
Respiratory rate >28/min 2.7 (1.4, 0.9 (0.8, 9–38
5.1) 0.9)
Oxygen saturation <95% 3 (2.2, 4.2) 0.7 (0.6, 11–51
0.8)
All vital signs normal 0.3 (0.2, 2.3 (1.5, 7–38
0.5) 3.4)
Asymmetric chest expansion 44.1 (2.1, 1 (0.9, 1) 10
905)
Chest wall tenderness 1.2 (0.3, 1 (0.9, 1.1) 16
5.3)
Percussion dullness 3.6 (2.4, 0.9 (0.9, 1) 3–38

CI) CI) (Range)
5.4)
CI) CI) (Range)
Diminished breath sounds 2.4 (1.9, 3) 0.8 (0.8, 5–41
0.9)
Bronchial breath sounds 3.3 (2.3, 0.9 (0.8, 14–20
4.8) 0.9)
Egophony 4.1 (2.1, 0.9 (0.9, 1) 3–38
7.8)
Crackles 2.8 (1.8, 0.8 (0.7, 3–41
4.4) 0.8)
Wheezing 0.8 (0.7, 1.1 (1, 1.1) 5–41
0.9)
0 or 1 findings 0.3 (0.2, … 7–35
0.4)
2 or 3 findings 1 (0.9, 1.2) … 15–35
4 or 5 findings 8.2 (5.8, … 15–35
11.5)
EBM Box 32.2: Pneumonia and mortality
Abnormal mental status 3.9 (3.1, 5) 0.8 (0.8, 1–31
0.9)
Heart rate >125/min 2.6 (2.2, 0.9 (0.8, 1) 7–16
3.1)
Systolic blood pressure <90 mm Hg 5.3 (3.6, 0.7 (0.6, 1–10

CI) CI) (Range)
7.8) 0.9)
CI) CI) (Range)
Hypothermia 3.5 (1.1, 0.8 (0.5, 4–9
10.9) 1.2)
Respiratory rate ≥30/min 2.4 (2.1, 0.9 (0.8, 2–17
2.8) 0.9)
Oxygen saturation <90% 2.8 (1.4, 0.8 (0.6, 1) 1–10
5.8)
CURB-65 0 0.2 (0.2, … 1–20
0.3)
CURB-65 1 0.6 (0.5, … 1–20
0.6)
CURB-65 2 1.3 (1.1, … 1–20
1.6)
CURB-65 3 2.5 (2.1, 3) … 1–20
CURB-65 4 5.4 (4.2, 7) … 1–20
CURB-65 5 8.4 (5.6, … 4–20
12.5)
Chapter 33 Chronic obstructive lung disease
Early inspiratory crackles, detecting severe 20.8 (3, 0.1 (0, 0.4) 48
disease 142.2)
CI) CI) (Range)
Any crackles, detecting chronic obstructive 0.9 (0.5, 1 (1, 1) 40–44
pulmonary disease 1.6)
EBM Box 33.1 Chronic obstructive pulmonary disease
Barrel chest 1.5 (1.2, 2) 0.6 (0.4, 49
0.8)
AP/L chest diameter ratio ≥0.9 2 (1.1, 3.3) 0.8 (0.7, 1) 49
Pursed lip breathing 2.7 (1.8, 4) 0.5 (0.4, 49
0.7)
Scalene/sternomastoid muscle use 3.3 (1.8, 0.7 (0.6, 49
5.9) 0.8)
Maximum laryngeal height ≤4 cm 3.6 (2.1, 6) 0.7 (0.6, 52
0.8)
Laryngeal descent, >3 cm 0.9 (0.5, 1 (0.9, 1.1) 52
1.4)
Hoover sign 4.2 (2.5, 7) 0.5 (0.4, 37
0.7)
Subxiphoid cardiac impulse 7.4 (2, 0.9 (0.7, 16–44
27.1) 1.1)
Absent cardiac dullness left lower sternum 11.8 (1.2, 0.9 (0.7, 14
121) 1.1)
Hyperresonance upper right anterior chest 7.3 (3.6, 0.8 (0.7, 16–40
CI) CI) (Range)
14.9) 0.9)
CI) CI) (Range)
Diaphragm excursion <2 cm 5.3 (0.8, 0.9 (0.7, 16
35) 1.1)
Reduced breath sounds 3.5 (2.1, 0.5 (0.4, 15–49
5.6) 0.7)
Breath sound score ≤9 10.2 (4.6, … 19–56
22.7)
9.5)
1.5)
Breath sound score ≥16 0.1 (0, 0.3) … 19–56
Early inspiratory crackles 14.6 (3, 70) 0.4 (0.1, 15–55
1.4)
Any unforced wheeze 2.6 (1.7, 0.8 (0.7, 13–83
3.9) 0.9)
Forced expiratory time 9 or more seconds 3.9 (2.7, … 50–71
5.7)
Forced expiratory time 3–9 seconds 1.1 (0.8, … 50–71
1.4)
Forced expiratory time <3 seconds 0.2 (0.1, … 50–71

CI) CI) (Range)
0.3)
CI) CI) (Range)
≥2 combined findings 25.7 (6.2, 0.3 (0.2, 16
106) 0.7)
EBM Box 33.2 Prognosis of COPD
BAP-65 class 1 0.3 (0.2, … 3–11
0.4)
BAP-65 class 2 0.4 (0.3, … 3–11
0.6)
BAP-65 class 3 1 (0.9, 1.2) … 3–11
BAP-65 class 4 3.7 (3.2, … 3–11
4.3)
BAP-65 class 5 9 (6.2, … 3–11
13.2)
Chapter 34 Pulmonary embolism
Sudden dyspnea 2.4 (2, 2.9) 0.3 (0.2, 40–43
0.3)
Syncope 2 (1.6, 2.5) 0.9 (0.8, 1) 19–40
Hemoptysis 1.9 (1.5, 1 (0.9, 1) 12–43
2.5)
Pulse <90/min 0.3 (0.1, 1.8 (1.3, 33
0.8) 2.5)
PaO2 <80 mm Hg 1.1 (1, 1.3) 0.7 (0.4, 28–36

CI) CI) (Range)
1.1)
CI) CI) (Range)
A-a gradient ≤20 mm Hg 0.6 (0.4, 1.2 (0.9, 27–36
1.01) 1.5)
PERC negative and low clinical probability 0.1 (0.1, 1.2 (1.2, 2–12
0.2) 1.3)
EBM Box 34.1 Pulmonary embolism
Diaphoresis 0.6 (0.3, 1 (1, 1.1) 23
1.4)
Cyanosis 2.3 (0.4, 1 (1, 1) 21–23
15.6)
Pulse rate >100/min 1.4 (1.1, 0.9 (0.8, 1) 12–43
1.7)
Systolic blood pressure ≤100 mm Hg 1.9 (1.1, 3) 1 (0.9, 1) 27
Temperature >38°C 0.5 (0.3, 1.1 (1, 1.1) 21–43
0.9)
Respiratory rate >30/min 2 (1.5, 2.8) 0.9 (0.8, 28
0.9)
Accessory muscle use 1.5 (0.6, 0.9 (0.8, 21
3.6) 1.1)
Crackles 0.8 (0.4, 1.1 (0.7, 23–38
1.6) 1.8)
Wheezes 0.4 (0.1, 1.1 (1, 1.2) 23–40

CI) CI) (Range)
0.97)
CI) CI) (Range)
Pleural friction rub 1.4 (0.6, 1 (1, 1) 21–23
3.1)
Elevated neck veins 1.7 (1.1, 1 (0.9, 1) 21–38
2.6)
Left parasternal heave 2.4 (1.03, 1 (1, 1) 21–23
5.5)
Loud P2 2 (0.8, 5.1) 0.9 (0.8, 1) 22–33
New gallop (S3 or S4) 2.7 (1, 7) 0.8 (0.6, 1) 33
Chest wall tenderness 0.8 (0.6, 1.1 (1, 1.1) 21–23
1.1)
Unilateral calf pain or swelling 2.9 (2.2, 4) 0.8 (0.7, 12–43
0.8)
Wells score low probability 0.3 (0.2, … 9–43
0.4)
Wells moderate probability 1.6 (1.4, … 9–43
1.8)
Wells high probability 8.2 (5, … 9–43
13.5)
Revised Geneva low probability 0.4 (0.3, … 15–32
0.5)
Revised Geneva moderate probability 1.1 (1, 1.3) … 15–32

CI) CI) (Range)

CI) CI) (Range)
Revised Geneva high probability 5.9 (4.5, … 15–32
7.6)
Chapter 35 Pleural effusion
Diminished breath sounds, detecting underlying 3 (1.5, 6) 0.7 (0.6, 26–48
pleural effusion in mechanically ventilated 0.9)
patients
EBM Box 35.1 Pleural effusion
Asymmetric chest expansion 8.1 (5.2, 0.3 (0.2, 21
12.7) 0.4)
Reduced tactile fremitus 5.7 (4, 8) 0.2 (0.1, 20
0.4)
Dullness by conventional percussion 4.8 (3.6, 0.1 (0.1, 21
6.4) 0.3)
Auscultatory percussion (Guarino method) 8.3 (1.8, 0.2 (0, 1.6) 21–40
38.7)
Decreased or absent breath sounds 5.2 (3.8, 0.1 (0.1, 21
7.1) 0.3)
Diminished vocal resonance 6.5 (4.4, 0.3 (0.2, 20
9.6) 0.4)
Crackles 0.7 (0.5, 1) 1.5 (1.1, 2) 21
Pleural rub 3.9 (0.8, 1 (0.9, 1) 21

CI) CI) (Range)
18.7)
CI) CI) (Range)
Chapter 36 Inspection of neck veins
Measured RA pressure ≥10 mm Hg, detecting 3.5 (2.2, 0.3 (0.2, 51–62
pulmonary capillary wedge pressure ≥22 Hg 5.7) 0.5)
Hand vein measure of venous pressure, detecting 4.9 (1.6, 0.8 (0.6, 34
CVP >12 mm Hg 14.3) 0.9)
Hand vein measure of venous, detecting CVP <7 2.3 (1.7, 0.1 (0, 0.8) 14
mm Hg 3.2)
Kussmaul sign, predicting mortality 3.5 (1.5, 0.7 (0.5, 43
8.1) 0.9)
Intermittent cannon a waves, detecting 3.8 (1.8, 0.1 (0, 0.4) 55
atrioventricular dissociation 8.2)
EBM Box 36.1 Inspection of neck veins
Elevated venous pressure, detecting CVP >8 cm 8.9 (4.6, 0.3 (0.2, 30–70
water 17.3) 0.5)
Elevated venous pressure, detecting CVP >12 cm 6.6 (2.7, 0.2 (0.1, 17–55
water 16.1) 0.4)
Elevated venous pressure, detecting elevated left 3.9 (1.6, 0.7 (0.5, 1) 19–75
heart diastolic pressures 9.4)
Elevated venous pressure, detecting low left 6.3 (3.5, 0.9 (0.8, 1) 8–69
ventricular ejection fraction 11.3)
Elevated venous pressure, detecting pulmonary 2.5 (1.2, 0.4 (0.3, 84

CI) CI) (Range)
hypertension 5.4) 0.6)
Elevated venous pressure, detecting myocardial 2.4 (1.4, 0.9 (0.9, 1) 6
infarction in patients with chest pain 4.2)
Elevated venous pressure, predicting 11.3 (5, 0.8 (0.7, 1) 4
postoperative pulmonary edema 25.8)
Elevated venous pressure, predicting 9.4 (4, 0.8 (0.7, 1) 4
postoperative myocardial infarction or CHF 22.4)
Estimated venous pressure ≤5 cm water, 8.4 (2.8, 0.1 (0, 0.7) 26
detecting measured venous pressure ≤5 cm water 25)
Positive abdominojugular test, detecting elevated 8 (2.1, 0.3 (0.2, 17–75
left heart diastolic pressures 31.2) 0.6)
Early systolic outward movement, detecting 10.9 (5.5, 0.7 (0.5, 18
moderate-to-severe tricuspid regurgitation 21.7) 0.8)
EBM Box 37.1 Percussion of the heart
Cardiac dullness >10.5 cm from midsternal line 2.5 (1.8, 0.05 (0, 0.3) 36
(patient supine), detecting cardiothoracic ratio 3.4)
>0.5
Cardiac dullness extending >10.5 cm from 1.4 (1.1, 0.2 (0, 1.3) 17
midsternal line (patient supine), detecting 1.7)
increased left ventricular end-diastolic volume
Cardiac dullness extending beyond midclavicular 2.4 (1.1, 0.1 (0, 0.4) 76
CI) CI) (Range)
line (patient upright), detecting cardiothoracic 5.2)
ratio >0.5
Chapter 38 Palpation of the heart
RV heave, detecting PA pressure ≥25 mm Hg in 2.7 (0.9, 0.7 (0.5, 84
pulmonary hypertension clinic 7.8) 0.9)
Palpable P2, detecting PA pressure ≥25 mm Hg in 0.9 (0.5, 1.1 (0.7, 84
pulmonary hypertension clinic 1.7) 1.5)
EBM Box 38.1 Size and position of apical impulse
Supine apical impulse lateral to MCL, detecting 3.4 (1.6, 0.6 (0.5, 25–28
cardiothoracic ratio >0.5 7.3) 0.8)
Supine apical impulse lateral to MCL, detecting 10.3 (5, 0.7 (0.6, 8–69
low ejection fraction 21.1) 0.9)
Supine apical impulse lateral to MCL, detecting 5.1 (2.7, 0.7 (0.6, 15–48
increased left ventricular end-diastolic volume 9.7) 0.8)
Supine apical impulse lateral to MCL, detecting 5.8 (1.3, 0.6 (0.4, 1) 30
pulmonary capillary wedge pressure >12 mm Hg 26)
Supine apical impulse >10 cm from midsternal 4.3 (0.3, 0.5 (0.3, 25–36
line, detecting cardiothoracic ratio >0.5 70.8) 0.8)

CI) CI) (Range)
Apical beat diameter ≥4 cm in left lateral 4.7 (2.1, 0.4 (0.2, 1) 32–50
decubitus position at 45°, detecting increased left 10.2)
ventricular end diastolic volume
EBM Box 38.2 Abnormal palpable movements
Hyperkinetic apical movement, detecting 11.2 (6.4, 0.3 (0.2, 39
associated mitral regurgitation or aortic valve 19.5) 0.4)
disease in patients with mitral stenosis
Sustained or double supine apical impulse, 5.6 (3.3, 0.5 (0.3, 27
detecting left ventricular hypertrophy 9.5) 0.7)
Sustained apical movement detecting aortic 4.1 (1.7, 0.3 (0.1, 69
stenosis in patients with aortic flow murmurs 10.1) 0.5)
Sustained apical movement, detecting moderate- 2.4 (1.4, 4) 0.1 (0, 0.9) 41
to-severe aortic regurgitation in patients with
basal early diastolic murmurs
Lower sternal movements, detecting moderate- 12.5 (4.1, 0.8 (0.8, 18
to-severe tricuspid regurgitation 38) 0.9)
Sustained left lower parasternal movement, 3.6 (1.4, 0.4 (0.2, 51
detecting right ventricular peak pressure ≥50 mm 8.9) 0.7)
Hg
CI) CI) (Range)
RV rock, detecting moderate-to-severe tricuspid 31.4 (1.6, 0.9 (0.9, 1) 18
regurgitation 601)
Pulsatile liver, detecting moderate-to-severe 6.5 (2.2, 0.8 (0.7, 1) 18–41
tricuspid regurgitation 19.3)
Palpable S2, detecting pulmonary hypertension in 3.6 (1.5, 0.05 (0, 0.8) 52
patients with mitral stenosis 8.8)
EBM Box 40.1 First and second heart sounds
Varying intensity of S1, detecting atrioventricular 24.4 (1.5, 0.4 (0.3, 55
dissociation 385) 0.7)
Fixed wide splitting of S2, detecting atrial septal 2.6 (1.6, 0.1 (0, 0.8) 30
defect 4.3)
Paradoxical splitting of S2, detecting significant 2.4 (0.8, 7) 0.6 (0.2, 5
aortic stenosis 1.7)
Loud P2, detecting pulmonary hypertension if 1.2 (0.9, 0.8 (0.3, 32–52
mitral stenosis 1.5) 1.9)
Loud P2, detecting pulmonary hypertension if 17.6 (2.1, 0.6 (0.4, 15
cirrhosis 149) 1.1)
Palpable P2, detecting pulmonary hypertension 3.6 (1.5, 0.05 (0, 0.8) 52
8.8)
CI) CI) (Range)
Absent or soft S2, detecting severe aortic stenosis 3.8 (2.4, 6) 0.4 (0.4, 5–60
in patients with aortic flow murmurs 0.5)
Chapter 41 Third and fourth heart sounds
S3 in mitral regurgitation, detecting elevated 1.7 (1,3) 0.7 (0.5, 76
filling pressure 0.9)
S3 in mitral regurgitation, detecting low ejection 1.9 (1.2, 0.6 (0.4, 34
fraction 2.9) 0.9)
S3 in aortic stenosis, detecting pulmonary 2.3 (1.3, 4) 0.9 (0.8, 1) 46
capillary wedge pressure >12 mm Hg
S3 in aortic stenosis, detecting ejection fraction 5.7 (2.7, 0.8 (0.7, 41
<0.5 12) 0.9)
S3 in aortic regurgitation, detecting severe 5.9 (1.4, 0.8 (0.7, 50
regurgitation 25.3) 0.9)
S3 in aortic regurgitation, detecting ejection 8.3 (3.6, 0.4 (0.2, 8
fraction <0.5 19.2) 0.9)
EBM Box 41.1 Third and fourth heart sounds
S3, detecting ejection fraction <0.5 3.4 (2.6, 0.7 (0.5, 30–80
4.4) 0.8)
S3, detecting ejection fraction <0.3 4.1 (2.3, 0.3 (0.2, 19–47
7.3) 0.5)
S3, detecting elevated left heart filling pressure 3.9 (2.1, 0.8 (0.7, 19–68
CI) CI) (Range)
7.1) 0.9)
CI) CI) (Range)
S3, detecting elevated BNP level 10.1 (4.2, 0.5 (0.3, 50–61
23.9) 0.8)
S3, detecting myocardial infarction in patients 3.2 (1.6, 0.9 (0.8, 1) 12
with acute chest pain 6.5)
S3, predicting postoperative pulmonary edema 14.6 (5.7, 0.8 (0.7, 1) 4
37.3)
S3, predicting postoperative myocardial infarction 8 (2.7, 0.9 (0.8, 1) 4
or cardiac death 23.4)
S4, detecting elevated left heart filling pressures 1.3 (0.8, 0.9 (0.7, 46–67
1.9) 1.2)
S4, detecting severe aortic stenosis 0.9 (0.5, 1.1 (0.6, 5–90
1.9) 1.9)
S4, predicting 5-year mortality in patients after 3.2 (1.3, 0.8 (0.6, 9
myocardial infarction 7.8) 1.1)
EBM Box 43.1 Murmurs and valvular heart disease
Functional murmur, detecting normal 5.4 (2.9, 0.1 (0.1, 21–88
echocardiogram 10.2) 0.4)
Characteristic murmur, detecting mild or worse 10.5 (2.8, 0.1 (0.1, 13–20
aortic stenosis 40) 0.3)

CI) CI) (Range)
Characteristic murmur, detecting severe aortic 3.5 (3.1, 4) 0.1 (0, 0.2) 2–26
stenosis
Characteristic murmur, detecting pulmonic 55.4 (7.1, 0.4 (0.2, 1) 7
stenosis 432)
mitral regurgitation 7.8) 0.6)
Characteristic murmur, detecting moderate or 3.8 (2, 7) 0.4 (0.3, 8–20
severe mitral regurgitation 0.5)
tricuspid regurgitation 19.8) 1.1)
Characteristic murmur detecting moderate or 10.3 (6.7, 0.7 (0.5, 7–18
severe tricuspid regurgitation 16) 0.9)
Characteristic murmur, detecting ventricular 28.1 (12.5, 0.1 (0, 0.4) 4–13
septal defect 63)
Characteristic murmur, detecting mitral valve 12.1 (4, 0.5 (0.2, 11
prolapse 36.4) 0.9)
Characteristic murmur, detecting mild aortic 10.1 (5.3, 0.3 (0.3, 23–88
regurgitation or worse 19.2) 0.4)
Characteristic murmur, detecting moderate or 4.3 (2.1, 0.1 (0.1, 8–35
severe aortic regurgitation 8.6) 0.2)
Characteristic murmur, detecting pulmonic 17.4 (3.6, 0.9 (0.8, 1) 15

CI) CI) (Range)
regurgitation 83.2)
Characteristic murmur, detecting mitral stenosis 31.2 (7.9, 0.1 (0, 0.3) 32
123)
EBM Box 43.2 Differential diagnosis of systolic murmurs in adults
Detecting aortic stenosis
Broad apical-base murmur pattern 9.7 (6.7, 0.1 (0.1, 20
14) 0.2)
Broad apical murmur pattern 0.2 (0.1, 1.1 (1.1, 20
0.9) 1.2)
LLSB murmur pattern 0.7 (0.2, 1 (1, 1.1) 20
2.4)
S1 inaudible 5.1 (3.5, 0.5 (0.4, 20
7.4) 0.6)
S2 inaudible 12.7 (5.3, 0.7 (0.6, 21
30.4) 0.8)
S2 loud 1.7 (0.9, 0.9 (0.8, 1) 21
3.1)
Radiation to neck 2.4 (1.9, 3) 0.2 (0.1, 33
0.3)
Timing mid-systolic or early systolic 0.4 (0.3, 2 (1.5, 2.5) 33

CI) CI) (Range)
0.6)
CI) CI) (Range)
Timing long systolic or holosystolic 2.2 (1.7, 0.4 (0.3, 33
2.8) 0.6)
Coarse quality murmur 3.3 (2.4, 0.3 (0.2, 33
4.5) 0.4)
Murmur same intensity in beat after pause 0.4 (0.2, 1.9 (1.3, 36
0.7) 2.8)
Detecting moderate or severe mitral regurgitation
Broad apical-base murmur pattern 1.1 (0.7, 1 (0.8, 1.1) 20
1.7)
Broad apical murmur pattern 6.8 (3.9, 0.7 (0.6, 20
11.9) 0.8)
LLSB murmur pattern 1.1 (0.4, 1 (0.9, 1.1) 20
3.4)
S1 inaudible 1.4 (0.9, 0.9 (0.8, 20
2.2) 1.1)
S2 inaudible 0.5 (0.2, 1.1 (1, 1.1) 20
1.6)
S2 loud 4.7 (2.7, 0.7 (0.6, 20
8.3) 0.9)
Radiation to neck 0.6 (0.4, 1.6 (1.2, 28

CI) CI) (Range)
0.9) 2.1)
CI) CI) (Range)
Timing mid-systolic or early systolic 0.4 (0.2, 1.9 (1.5, 28
0.6) 2.5)
2.4) 0.7)
0.8) 1.8)
4.3) 0.7)
Detecting moderate or severe tricuspid regurgitation
Broad apical-base murmur pattern 0.8 (0.4, 1.1 (0.9, 18
1.3) 1.3)
Broad apical murmur pattern 2.5 (1.4, 0.8 (0.7, 1) 18
4.5)
LLSB murmur pattern 8.4 (3.5, 0.8 (0.7, 18
20.3) 0.9)
S1 inaudible 1 (0.6, 1.7) 1 (0.9, 1.1) 18
S2 inaudible 1.4 (0.6, 1 (0.9, 1.1) 18
3.3)
S2 loud 3.6 (2.1, 0.7 (0.6, 18
6.3) 0.9)
Radiation to neck 0.6 (0.4, 1.5 (1.2, 2) 22

CI) CI) (Range)
0.9)
CI) CI) (Range)
Timing mid-systolic or early systolic 0.5 (0.3, 1.7 (1.3, 22
0.8) 2.1)
2.2) 0.8)
0.9) 1.8)
3.6) 0.8)
EBM Box 43.3 Systolic murmurs and maneuvers
Murmur louder with inspiration, detecting right- 7.8 (3.7, 0.2 (0.1, 20–50
sided murmur 16.7) 0.5)
Murmur louder with Valsalva strain, detecting 14 (3.4, 0.3 (0.1, 20
hypertrophic cardiomyopathy 57.4) 0.8)
Murmur louder with squatting-to-standing, 6 (2.9, 0.1 (0, 0.8) 20
detecting hypertrophic cardiomyopathy 12.3)
Murmur softer with standing-to-squatting, 7.6 (2.5, 0.1 (0, 0.4) 20–41
Murmur softer with passive leg elevation, 9 (3.5, 0.1 (0, 0.7) 20

CI) CI) (Range)
Murmur softer with hand grip, detecting 3.6 (2, 6.4) 0.1 (0, 0.9) 20
hypertrophic cardiomyopathy
Murmur louder with hand grip, detecting mitral 5.8 (1.9, 0.3 (0.2, 40–65
regurgitation or ventricular septal defect 17.3) 0.5)
Murmur louder with transient arterial occlusion, 48.7 (3.1, 0.2 (0.1, 40
detecting mitral regurgitation or ventricular 769) 0.5)
septal defect
Murmur softer with amyl nitrite inhalation, 10.5 (5.1, 0.2 (0.1, 40–71
detecting mitral regurgitation or ventricular 21.5) 0.6)
septal defect
Chapter 44 Aortic stenosis
Effort syncope and aortic murmur, detecting 3.1 (1.3, 0.9 (0.8, 1) 70–75
severe aortic stenosis 7.3)
Angina and aortic murmur, detecting severe 0.9 (0.7, 1) 1.3 (0.9, 70
aortic stenosis 1.9)
Dyspnea and aortic murmur, detecting severe 1.4 (0.6, 0.8 (0.4, 70
aortic stenosis 3.1) 1.5)
Calcification of aortic valve on CXR, detecting 3.9 (2.1, 0.5 (0.4, 49–70
severe aortic stenosis 7.3) 0.7)
ECG LVH, detecting severe aortic stenosis 2.1 (1.7, 0.5 (0.4, 13–70
CI) CI) (Range)
2.7) 0.6)
CI) CI) (Range)
Delayed carotid artery upstroke, detecting 7.6 (3.8, 0.5 (0.4, 13–57
moderate-to-severe aortic stenosis 15.1) 0.7)
Absent or diminished S2, detecting moderate-to- 7.4 (2.8, 0.5 (0.4, 13–57
Prolonged duration of murmur, detecting 11.4 (1.3, 0.3 (0.2, 24–57
moderate-to-severe aortic stenosis 97.2) 0.4)
Murmur late peaking, detecting moderate-to- 13.7 (2.9, 0.3 (0.2, 24–49
0 to 6 points, detecting moderate-to-severe aortic 0.2 (0.1, 4.7 (1.9, 73
stenosis 0.4) 11.4)
7 to 9 points, detecting moderate-to-severe aortic 2.7 (0.9, … 73
stenosis 8.1)
10 to 14 points, detecting moderate-to-severe 10.6 (1.5, 0.6 (0.4, 73
aortic stenosis 73.3) 0.7)
EBM Box 44.1 Aortic stenosis murmur
Aortic systolic murmur, detecting mild or worse 10.5 (2.8, 0.1 (0.1, 13–20
aortic stenosis 40) 0.3)
Aortic systolic murmur, detecting severe aortic 3.5 (3.1, 4) 0.1 (0, 0.2) 2–26
stenosis
EBM Box 44.2 Severe aortic stenosis
Delayed carotid artery upstroke 3.5 (2.6, 0.4 (0.2, 5–69

CI) CI) (Range)
4.6) 0.7)
CI) CI) (Range)
Reduced carotid artery volume 2.3 (1.8, 0.4 (0.3, 28–69
2.9) 0.7)
Brachioradial delay 2.5 (1.4, 0.04 (0, 0.7) 52
4.7)
Sustained apical impulse 4.1 (1.7, 0.3 (0.1, 69
10.1) 0.5)
Apical-carotid delay 2.6 (1.4, 0.05 (0, 0.7) 53
5.2)
Absent or soft S2 3.8 (2.4, 6) 0.4 (0.4, 5–60
0.5)
S4 gallop 0.9 (0.5, 1.1 (0.6, 5–90
1.9) 1.9)
Murmur grade ≥3/6 1.2 (1, 1.4) 0.8 (0.5, 29–70
1.3)
Murmur early systolic 0.1 (0, 0.7) 1.6 (1.3, 2) 28
Murmur prolonged duration 3 (1.7, 5.2) 0.2 (0.1, 5–28
0.4)
Murmur late peaking 3.7 (2.6, 0.2 (0.1, 5–75
5.2) 0.2)
Murmur loudest over aortic area 1.8 (1.1, 0.6 (0.4, 5–49
CI) CI) (Range)
2.9) 0.7)
CI) CI) (Range)
Murmur radiates to neck 1.4 (1.1, 0.1 (0.1, 5–49
1.8) 0.3)
Murmur radiates to both sides of neck 1.9 (1.1, 0.7 (0.4, 1) 28
3.4)
Murmur quality blowing 0.1 (0, 0.8) 1.4 (1.2, 28
1.7)
Murmur with humming quality 2.1 (1.3, 0.5 (0.3, 28
3.5) 0.9)
EBM Box 45.1 Aortic regurgitation
Characteristic diastolic murmur, detecting mild 10.1 (5.3, 0.3 (0.3, 23–88
aortic regurgitation or worse 19.2) 0.4)
Characteristic diastolic murmur, detecting 4.3 (2.1, 0.1 (0.1, 8–35
moderate or severe aortic regurgitation 8.6) 0.2)
Murmur loudest on right side of sternum, 8.2 (5, 0.7 (0.7, 14
detecting dilated aortic root or endocarditis 13.3) 0.8)
Murmur softer with amyl nitrite, detecting aortic 5.7 (0.5, 0.1 (0, 0.3) 93
regurgitation (vs. Graham Steell murmur) 71.4)
EBM Box 45.2 Moderate-to-severe aortic regurgitation
Murmur grade 3 or louder 8.2 (2.2, 0.6 (0.4, 24–45
31.1) 0.9)
Diastolic blood pressure >70 mm Hg 0.2 (0.1, … 41–56

CI) CI) (Range)
0.9)
CI) CI) (Range)
Diastolic blood pressure 51–70 mm Hg 1.1 (0.7, … 41–56
1.7)
Diastolic blood pressure ≤50 mm Hg 19.3 (2.7, … 41–56
141)
Pulse pressure <60 mm Hg 0.3 (0.1, … 42
0.9)
Pulse pressure 60–79 mm Hg 0.8 (0.2, … 42
2.9)
Pulse pressure ≥80 mm Hg 10.9 (1.5, … 42
77.1)
Hill’s test, difference >40 mm Hg 6 (2, 17.9) 0.5 (0.3, 42–90
0.8)
Enlarged or sustained apical impulse 2.4 (1.4, 4) 0.1 (0, 0.9) 41
S3 gallop 5.9 (1.4, 0.8 (0.7, 50
25.3) 0.9)
Duroziez’s sign, femoral pistol shot, water 3.4 (0.4, 0.7 (0.5, 41–75
hammer pulse 31) 0.9)
Chapter 46 Miscellaneous heart murmurs
Apical mid-diastolic rumble, detecting mitral 7.5 (2.3, 0.9 (0.9, 1) 55
annular calcification 24.4)
EBM Box 46.1 Moderate-to-severe mitral or tricuspid regurgitation

CI) CI) (Range)
MR murmur grade 3 or louder 4.4 (2.9, 0.2 (0.1, 42
6.7) 0.3)
S3 gallop (MR) 4.4 (0.6, 0.8 (0.7, 49–62
31.8) 0.8)
CV wave, neck veins (TR) 10.9 (5.5, 0.7 (0.5, 18
21.7) 0.8)
Lower sternal precordial pulsation (TR) 12.5 (4.1, 0.8 (0.8, 18
38) 0.9)
RV rock (TR) 31.4 (1.6, 0.9 (0.9, 1) 18
601)
Pulsatile liver (TR) 6.5 (2.2, 0.8 (0.7, 1) 18–41
19.3)
EBM Box 46.2 Other findings in mitral stenosis
Graham Steell murmur, detecting pulmonary 4.2 (1.1, 0.4 (0.2, 52
hypertension 15.5) 0.9)
Hyperkinetic apical movement, detecting 11.2 (6.4, 0.3 (0.2, 39
associated mitral regurgitation or aortic valve 19.5) 0.4)
disease
CI) CI) (Range)
Hyperkinetic arterial pulse, detecting associated 14.2 (7.4, 0.3 (0.2, 35
mitral regurgitation 27.2) 0.4)
Chapter 47 Disorders of the pericardium
Fever, detecting specific diagnosis (e.g., 4.3 (2.9, 0.6 (0.5, 17
neoplasia, autoimmune, bacterial infection) 6.4) 0.8)
Fever, detecting idiopathic or viral pericarditis 0.2 (0.2, 1.6 (1.3, 83
0.3) 1.9)
Pericardial rub in patient with cancer and 5.5 (1.4, 0.4 (0.2, 42
pericarditis, detecting idiopathic or radiation- 21.9) 0.9)
induced pericarditis (not neoplastic)
Pericardial rub and inflammatory signs in patient 2.3 (1.1, 0.7 (0.6, 87
with pericarditis, detecting non-neoplastic 4.6) 0.9)
pericarditis
Pulsus paradoxus >12 mm Hg, detecting cardiac 5.9 (2.4, 0.03 (0, 0.2) 63
tamponade 14.3)
Oximetry paradoxus <1.2, detecting cardiac 0.05 (0, 2.1 (1.5, 26
tamponade 0.7) 2.7)
Tamponade, predicting a specific etiology will be 21.5 (6.3, 0.8 (0.8, 17
found 73.6) 0.9)
Chapter 48 Congestive heart failure
Crackles, detecting elevated filling pressure in 2.1 (1.2, 0.8 (0.7, 1) 54–86
CI) CI) (Range)
patients with known cardiomyopathy 3.8)
Pulse-amplitude ratio >0.7, detecting wedge 5.2 (1.7, 0.5 (0.3, 1) 39–55
pressure >15 mm Hg 16.6)
Cheyne-Stokes respirations, detecting ejection 8.1 (4, 0.7 (0.6, 21
fraction <0.40 (age 80 years or less) 16.3) 0.8)
Cheyne-Stokes respirations, detecting ejection 2.7 (1.1, 0.7 (0.4, 17
fraction <0.40 (age >80 years) 6.6) 1.1)
S3 gallop, detecting ejection fraction <30% 4.1 (2.3, 0.3 (0.2, 19–47
7.3) 0.5)
Proportional pulse pressure ≤25%, detecting low 6.9 (3, 0.2 (0.1, 50–64
S3, detecting consensus diagnosis of heart failure 7.7 (5.6, 0.9 (0.9, 29–55
10.6) 0.9)
Displaced apical impulse, detecting consensus 6.7 (4, 11) 0.8 (0.7, 29
diagnosis of heart failure 0.8)
Elevated neck veins, detecting consensus 4 (3.2, 5) 0.7 (0.7, 29–71
diagnosis of heart failure 0.8)
BNP ≥100, detecting consensus diagnosis of 2.7 (2, 3.7) 0.1 (0.1, 35–62
heart failure 0.2)

CI) CI) (Range)
Cold profile if heart failure, predicting early 3 (2, 4.5) 0.7 (0.6, 5–18
mortality 0.8)
EBM Box 48.1 Detecting elevated left heart filling pressure
Heart rate >100/min at rest 5.5 (1.3, 0.9 (0.9, 1) 19
24.1)
Abnormal Valsalva response 7.6 (1.7, 0.1 (0, 0.8) 48
34.3)
Pulse increase of 10% during Valsalva strain 0.2 (0.1, 1.7 (1.3, 25
0.9) 2.2)
Crackles 1.6 (0.8, 0.9 (0.9, 1) 19–77
2.9)
Elevated jugular venous pressure 3.9 (1.6, 0.7 (0.5, 1) 19–75
9.4)
Positive abdominojugular test 8 (2.1, 0.3 (0.2, 17–75
31.2) 0.6)
Supine apical impulse lateral to MCL 5.8 (1.3, 0.6 (0.4, 1) 30
26)
S3 gallop 3.9 (2.1, 0.8 (0.7, 19–68
7.1) 0.9)
S4 gallop 1.3 (0.8, 0.9 (0.7, 46–67

CI) CI) (Range)
1.9) 1.2)
CI) CI) (Range)
Edema 1.4 (0.6, 1 (0.9, 1) 19–68
3.2)
Bendopnea test 3.2 (1.6, 0.6 (0.5, 45
6.5) 0.8)
EBM Box 48.2 Detecting low ejection fraction
Heart rate >100 beats/min at rest 2.8 (1.3, 0.8 (0.7, 1) 16
5.9)
Cheyne-Stokes respirations 5.4 (3.2, 0.7 (0.6, 20
9.2) 0.8)
Abnormal Valsalva response 7.6 (4.9, 0.3 (0.2, 41–46
11.8) 0.4)
Crackles 1.5 (0.9, 0.9 (0.8, 1) 8–69
2.4)
Elevated jugular venous pressure 6.3 (3.5, 0.9 (0.8, 1) 8–69
11.3)
Supine apical impulse lateral to MCL 10.3 (5, 0.7 (0.6, 8–69
21.1) 0.9)
S3 gallop 3.4 (2.6, 0.7 (0.5, 30–80
4.4) 0.8)
S4 gallop 1.2 (0.8, 0.9 (0.5, 30–60

CI) CI) (Range)
1.9) 1.4)
CI) CI) (Range)
Murmur of mitral regurgitation 2.2 (0.9, 0.8 (0.7, 1) 56
5.7)
Hepatomegaly 0.9 (0.1, 1 (0.9, 1.1) 69
9.4)
Edema 1.2 (0.8, 0.9 (0.9, 1) 8–69
1.8)
Chapter 49 Coronary artery disease
Cholesterol >300 mg/dL, detecting coronary 4 (2.5, 6.3) … 24–50
artery disease
Cholesterol <200 mg/dL, detecting coronary 0.3 (0.2, … 24–50
artery disease 0.4)
Right arm radiation, detecting myocardial 2.7 (1.9, 0.9 (0.8, 12–49
Left arm radiation, detecting myocardial 1.5 (1.3, 0.8 (0.7, 6–49
Chest wall tenderness, predicting acute coronary 0.1 (0, 0.4) 1.1 (1, 1.1) 20
syndrome in next 30 days
EBM Box 49.1 Coronary artery disease
Typical angina 5.8 (4.2, … 44–65
7.8)
Atypical angina 1.2 (1.1, … 44–58

CI) CI) (Range)
1.3)
CI) CI) (Range)
Non-anginal chest pain 0.1 (0.1, … 44–58
0.2)
Pain duration >30 minutes 0.1 (0, 0.9) 1.2 (1, 1.3) 50
Associated dysphagia 0.2 (0.1, 1.2 (1, 1.4) 50
0.8)
Male sex 1.6 (1.5, 0.4 (0.3, 44–83
1.8) 0.5)
Age <30 years 0.1 (0, 1.1) … 51–68
Age 30–49 years 0.6 (0.5, … 51–83
0.7)
Age 50–70 years 1.3 (1.3, … 51–83
1.4)
Age >70 years 2.6 (1.8, 4) … 51–90
Prior myocardial infarction 3.8 (2.1, 0.6 (0.5, 58–83
6.8) 0.6)
Ear lobe crease 2.1 (1.6, 0.5 (0.4, 29–85
2.8) 0.7)
Arcus senilis 3 (1.02, 0.7 (0.6, 89
8.6) 0.8)
Chest wall tenderness 0.8 (0.7, 1.1 (1, 1.3) 44–62

CI) CI) (Range)
0.9)
CI) CI) (Range)
Ankle-to-arm pressure index <0.9 3.6 (2.3, 0.9 (0.8, 1) 75–82
5.7)
Laterally displaced apical impulse 13 (0.7, 1 (0.9, 1) 50
228)
ECG normal 0.6 (0.3, 1.2 (1, 1.6) 44–58
1.1)
ECG with ST/T wave abnormalities 1.4 (1, 1.9) 0.9 (0.9, 1) 44–76
EBM Box 49.2 Myocardial infarction
Male sex 1.3 (1.2, 0.7 (0.7, 6–36
1.3) 0.7)
Age, <40 years 0.2 (0.1, … 17
0.5)
Age, 40–59 years 0.8 (0.6, … 17
1.1)
Age, ≥60 years 1.5 (1.4, … 14–36
1.6)
Sharp pain 0.5 (0.3, 1.2 (1.1, 12–21
0.9) 1.4)
Pleuritic pain 0.3 (0.2, 1.2 (1.1, 12–21
0.6) 1.2)
Positional pain 0.6 (0.3, 1.1 (1.1, 12–21

CI) CI) (Range)
1.01) 1.1)
CI) CI) (Range)
Relief of pain with nitroglycerin 1 (0.9, 1.1) 1 (0.9, 1.2) 18–34
Levine sign 0.5 (0.2, 1.1 (1, 1.2) 22
1.6)
Palm sign 0.9 (0.5, 1.1 (0.9, 22
1.4) 1.4)
Arm sign 1.1 (0.5, 1 (0.8, 1.2) 22
2.2)
Pointing sign 0.4 (0.1, 1 (1, 1.1) 22
3.5)
Chest wall tenderness 0.3 (0.2, 1.2 (1.2, 12–21
0.5) 1.3)
Diaphoretic appearance 2.2 (1.7, 0.7 (0.6, 12–29
2.9) 0.8)
Pallor 1.4 (1.2, 0.6 (0.5, 29
1.6) 0.8)
Systolic blood pressure <100 mm Hg 3.6 (2, 6.5) 1 (0.9, 1) 18
Jugular venous distension 2.4 (1.4, 0.9 (0.9, 1) 6
4.2)
Pulmonary crackles 2.1 (1.6, 0.8 (0.7, 1) 6–12
2.8)
Third heart sound 3.2 (1.6, 0.9 (0.8, 1) 12

CI) CI) (Range)
6.5)
CI) CI) (Range)
ECG normal 0.2 (0.1, … 14–42
0.3)
ECG non-specific ST changes 0.2 (0.1, … 14–29
0.4)
ECG T wave inversion 2 (1.7, 2.4) … 12–29
ECG ST depression 3.8 (3, 4.8) … 12–29
ECG ST elevation 18.4 (11.3, … 12–29
30)
Chapter 51 Palpation and percussion of the abdomen
Pulsatile liver, detecting moderate or worse TR 6.5 (2.2, 0.8 (0.7, 1) 18–41
19.3)
Lymphadenopathy, detecting hepatic cause of 0.1 (0, 0.1) 1.5 (1.1, 2) 11–42
splenomegaly
Massive splenomegaly, detecting hematologic 2.8 (2.4, 0.7 (0.6, 27–57
cause of splenomegaly 3.2) 0.8)
EBM Box 51.1 Detecting enlarged liver and spleen
Percussion span ≥10 cm, detecting enlarged liver 1.2 (1, 1.5) 0.5 (0.2, 20–74
1.7)
Palpable liver, detecting liver edge 234 (15, 0.5 (0.5, 51
3737) 0.6)
Palpable liver, detecting enlarged liver 1.9 (1.6, 0.6 (0.5, 20–44
CI) CI) (Range)
2.3) 0.8)
CI) CI) (Range)
Palpable spleen, detecting enlarged spleen 8.5 (6.2, 0.6 (0.5, 7–84
11.7) 0.7)
Spleen percussion sign, detecting enlarged spleen 1.7 (1.3, 0.7 (0.5, 26–63
2.2) 0.8)
Nixon method, detecting enlarged spleen 2 (1.2, 3.5) 0.7 (0.6, 26–61
0.9)
Traube space dullness, detecting enlarged spleen 2.1 (1.7, 0.8 (0.6, 36–61
2.6) 0.9)
EBM Box 51.2 Palpation of liver and spleen
Palpable enlarged liver, detecting cirrhosis 2.3 (1.6, 0.6 (0.4, 7–67
3.3) 0.7)
Palpable liver in epigastrium, detecting cirrhosis 2.7 (1.9, 0.3 (0.1, 7–37
3.9) 0.9)
Liver edge firm, detecting cirrhosis 3.3 (2.2, 0.4 (0.3, 27–67
4.9) 0.4)
Palpable liver (if jaundice), detecting 0.9 (0.8, 1.4 (0.6, 65–67
hepatocellular disease 1.1) 3.4)
Liver tenderness (if jaundice), detecting 1.4 (0.8, 0.8 (0.7, 65–67

CI) CI) (Range)
Palpable liver (if lymphadenopathy), detecting 1.2 (0.7, 1 (0.9, 1.1) 26–41
serious disease 1.9)
Palpable spleen in returning travelers with fever, 6.5 (3.9, 0.8 (0.8, 27–29
detecting malaria 10.7) 0.8)
Palpable spleen (if jaundice), detecting 2.9 (1.2, 0.7 (0.6, 65–67
Palpable spleen, detecting cirrhosis 2.5 (1.6, 0.8 (0.7, 18–67
3.8) 0.9)
Palpable spleen (if lymphadenopathy), detecting 1.2 (0.6, 1 (0.9, 1) 26–41
serious disease 2.5)
Palpable spleen (if prolonged fever), predicting 2.9 (1.9, 0.7 (0.5, 24–45
that bone marrow examination will be diagnostic 4.4) 0.8)
EBM Box 51.3 Palpation of gallbladder, bladder, and aorta
Palpable gallbladder (in jaundiced patients), 26 (1.5, 0.7 (0.5, 33
detecting extrahepatic obstruction 439.9) 0.9)
Palpable gallbladder, detecting malignant 2.6 (1.5, 0.7 (0.6, 32–80
extrahepatic obstruction 4.6) 0.9)
Palpable bladder, detecting ≥400 mL urine 1.9 (1.4, 0.3 (0.1, 29
2.6) 0.7)
CI) CI) (Range)
Expansile pulsating epigastric mass, detecting 8.4 (4.6, 0.6 (0.5, 2–50
abdominal aortic aneurysm 15.6) 0.7)
EBM Box 51.4 Ascites
Bulging flanks 1.9 (1.4, 0.4 (0.2, 24–33
2.6) 0.6)
Edema 3.8 (2.2, 0.2 (0, 0.6) 24
6.6)
Flank dullness 1.8 (0.9, 0.3 (0.1, 24–29
3.4) 0.7)
Shifting dullness 2.3 (1.5, 0.4 (0.2, 24–33
3.5) 0.6)
Fluid wave 5 (2.5, 9.9) 0.5 (0.3, 24–33
0.7)
Chapter 52 Abdominal pain and tenderness
Sonographic McBurney point tenderness, 8.4 (2.9, 0.1 (0.1, 67
detecting appendicitis 24.6) 0.3)
Sonographic Murphy sign, detecting cholecystitis 15.7 (5.6, 0.5 (0.3, 21–47
43.9) 0.7)
Murphy sign in patients with liver abscess, 2.8 (1.1, 0.8 (0.6, 1) 40
detecting biliary tract sepsis 6.9)
Left lower quadrant tenderness, detecting 13.8 (6.3, 0.8 (0.7, 17

CI) CI) (Range)
diverticulitis (surgical finding) 30) 0.9)
Left lower quadrant tenderness, detecting 2.2 (1.7, 0.4 (0.3, 43
diverticulitis (CT scan) 2.7) 0.5)
Guarding, detecting complicated diverticulitis 8.4 (2.5, 0.9 (0.9, 1) 17
28)
Loin tenderness, detecting ureterolithiasis 27.7 (10.7, 0.9 (0.8, 4
72) 0.9)
Renal tenderness, detecting ureterolithiasis 3.6 (3.1, 0.2 (0.1, 4
4.1) 0.3)
Microscopic hematuria, detecting ureterolithiasis 73.1 (41.7, 0.3 (0.2, 4
128) 0.4)
Positive abdominal wall tenderness test in 7 (3.4, 0.2 (0.1, 35
chronic abdominal pain, predicting improvement 14.3) 0.5)
with local analgesic injection
EBM Box 52.1 Acute abdominal pain, detecting peritonitis
Fever 1.4 (1.2, 0.7 (0.6, 31–88
1.7) 0.8)
Guarding 2.3 (1.9, 0.6 (0.5, 11–88
2.8) 0.7)
Rigidity 3.6 (2.7, 0.8 (0.7, 11–75

CI) CI) (Range)
4.8) 0.9)
CI) CI) (Range)
Rebound tenderness 2 (1.7, 2.3) 0.4 (0.4, 11–88
0.5)
Percussion tenderness 2.4 (1.5, 0.5 (0.4, 30–50
3.8) 0.6)
Abnormal bowel sounds 2.2 (0.5, 0.8 (0.7, 13–82
9.7) 0.9)
Rectal tenderness 1.4 (1, 1.8) 0.8 (0.7, 1) 11–82
Positive abdominal wall tenderness test 0.1 (0, 0.7) 1.9 (0.9, 58–72
4.4)
Positive cough test 1.9 (1.5, 0.5 (0.3, 11–46
2.4) 0.6)
EBM Box 52.2 Acute abdominal pain, detecting appendicitis
Right lower quadrant tenderness 1.9 (1.6, 0.3 (0.2, 11–85
2.4) 0.4)
McBurney point tenderness 3.4 (1.6, 0.4 (0.2, 39–65
7.2) 0.7)
Rovsing sign 2.1 (1.4, 0.8 (0.7, 36–58
3.2) 0.9)
Psoas sign 1.7 (1.3, 0.9 (0.8, 1) 36–82
2.3)
Obturator sign 1.5 (0.97, 0.9 (0.9, 1) 57–82

CI) CI) (Range)
2.2)
CI) CI) (Range)
Alvarado score 7 or more 3 (2.4, 3.7) … 17–82
Alvarado score 5–6 0.7 (0.4, … 17–82
1.2)
Alvarado score, 4 or less 0.1 (0.1, … 17–82
0.2)
EBM Box 52.3 Right upper quadrant tenderness
Fever 1.1 (0.8, 0.9 (0.8, 26–78
1.7) 1.1)
Right upper quadrant tenderness 2.4 (1.7, 0.4 (0.2, 10–80
3.4) 0.5)
Murphy sign (inspiratory arrest) 3.9 (1.9, 0.5 (0.4, 10–52
7.9) 0.7)
Right upper quadrant mass 0.8 (0.5, 1 (1, 1) 26–80
1.2)
EBM Box 52.4 Acute abdominal pain, detecting obstruction
Visible peristalsis 18.8 (4.3, 0.9 (0.9, 1) 4
81.9)
Distended abdomen 9.6 (5, 0.4 (0.3, 4–8
18.6) 0.5)
Guarding 1 (0.6, 1.7) 1 (0.7, 1.4) 4–8
Rigidity 1.2 (0.4, 1 (0.9, 1.2) 4–8

CI) CI) (Range)
3.6)
CI) CI) (Range)
Rebound tenderness 0.9 (0.7, 1.1 (1, 1.2) 4–8
1.1)
Hyperactive bowel sounds 5 (2.4, 0.6 (0.5, 4–8
10.6) 0.8)
Abnormal bowel sounds 3.2 (1.7, 0.4 (0.3, 4–8
6.1) 0.5)
Rectal tenderness 0.9 (0.6, 1 (1, 1.1) 4–8
1.5)
EBM Box 52-5 Chronic upper abdominal pain
Positive abdominal wall tenderness test, detecting 0.1 (0.1, 4.9 (3, 8) 60–65
visceral pain 0.3)
Right upper quadrant tenderness, detecting 1.1 (0.9, 0.9 (0.7, 41
cholelithiasis 1.4) 1.2)
Lower abdominal tenderness, detecting 0.5 (0.3, 1.4 (1.2, 41
cholelithiasis 0.7) 1.6)
Epigastric tenderness, detecting positive upper 0.9 (0.7, 1.2 (0.6, 61
endoscopy 1.3) 2.3)
Chapter 53 Auscultation of abdomen
Abnormal bowel sounds, detecting bowel 3.2 (1.7, 0.4 (0.3, 4–8
obstruction 6.1) 0.5)
EBM Box 53.1 Auscultation of abdomen

CI) CI) (Range)
Any abdominal bruit, detecting renovascular 5.6 (4, 7.7) 0.6 (0.5, 18–36
hypertension 0.8)
Any abdominal bruit, detecting abdominal aortic 2 (0.5, 8.6) 0.9 (0.8, 9
aneurysm 1.1)
Systolic/diastolic abdominal bruit, detecting 38.9 (9.5, 0.6 (0.5, 24
renovascular hypertension 160) 0.7)
Chapter 54 Peripheral vascular disease
ABI <0.9 by palpation, detecting ABI <0.9 by 4 (3, 5.2) 0.2 (0.1, 4–23
Doppler 0.3)
Pulse oximetry test positive (finger minus toe O2 30.5 (7.7, 0.2 (0.1, 31
sat ≥2% [supine patient] or toe O2 sat decreases 121) 0.4)
≥2% after elevating foot 12 inches
Absent or severely diminished femoral pulse, 31 (1.9, 0.6 (0.5, 50
detecting aortoiliac disease 500.6) 0.8)
Limb bruit (with preserved popliteal pulse), 3.2 (1.2, 0.3 (0.1, 68
detecting limb stenosis 8.7) 0.6)
Continuous femoral bruit, detecting 80.8 (5.1, 0.04 (0, 0.6) 23
arteriovenous fistula 1273)

CI) CI) (Range)
Expansile femoral pulsation, detecting false 13.8 (3.6, 0.1 (0, 0.3) 44
aneurysm 52.7)
Prolonged capillary refill time (after fluid 10.5 (2.8, 0.6 (0.4, 1) 14
resuscitation), predicting hospital mortality 38.8)
Prolonged capillary refill time (before fluid 1.6 (0.8, 0.7 (0.4, 14
resuscitation), predicting hospital mortality 3.3) 1.3)
Mottling diminishes during hospitalization, 0.2 (0.1, 3.8 (1.4, 66
predicting hospital mortality 0.5) 10.4)
EBM Box 54.1 Peripheral vascular disease
Wounds or sores on foot 7 (3.2, 1 (1, 1) 11
15.6)
Foot color abnormally pale, red, or blue 2.8 (2.4, 0.7 (0.7, 9
3.2) 0.8)
Atrophic skin 1.7 (1.2, 0.7 (0.5, 1) 8
2.3)
Absent lower limb hair 1.7 (1.2, 0.7 (0.6, 1) 8
2.3)
Foot asymmetrically cooler 6.1 (4.2, 0.9 (0.9, 8
8.9) 0.9)
Absent femoral pulse 6.1 (3.8, 0.9 (0.9, 1) 9

CI) CI) (Range)
10)
CI) CI) (Range)
Both pedal pulses absent (PT and DP) 9.9 (7.4, 0.4 (0.3, 7–71
13.2) 0.4)
Limb bruit present 5.4 (3.9, 0.7 (0.6, 9–67
7.3) 0.8)
Capillary refill time ≥5 seconds 1.9 (1.2, 0.8 (0.7, 1) 8
3.2)
Venous filling time >20 seconds 3.6 (1.9, 0.8 (0.7, 1) 8
6.8)
EBM Box 54.2 Hypoperfusion in ICU patients
Cool extremities in ICU patients, detecting low 3.7 (2.1, 0.8 (0.8, 55
Cool extremities in septic ICU patients, detecting 5.2 (2.3, 0.7 (0.6, 47
low cardiac index 12.1) 0.9)
0 of 3 findings present, detecting low cardiac 0.5 (0.3, … 8
index 0.8)
index 3.4)
All 3 findings present, detecting low cardiac 7.5 (2.2, … 8
index 25.3)
CI) CI) (Range)
Capillary refill time ≥5 seconds, detecting low 1.6 (1.2, 0.9 (0.8, 1) 36
cardiac output 2.2)
Limb is cool or capillary refill time >5 sec, 2.2 (1.6, 3) 0.5 (0.4, 50
detecting elevated lactate 0.7)
Limb is cool or capillary refill time >5 sec, 2.6 (1.9, 0.3 (0.2, 50
predicting multiorgan dysfunction 3.5) 0.5)
Capillary refill time ≥5 seconds, predicting major 12.1 (5.4, 0.2 (0.1, 17
postoperative complications 27.1) 0.5)
Capillary refill time ≥5 seconds, predicting 4.6 (1.7, 0.6 (0.4, 37
mortality if septic shock 12.8) 0.9)
Knee mottling, predicting mortality if septic 10.2 (3.2, 0.8 (0.6, 1) 11–52
shock 32)
Chapter 55 The diabetic foot
Insensate to 5.07 monofilament, predicting 2.6 (1.5, 0.4 (0.3, 1–4
amputation during 3–4 y f/u 4.6) 0.7)
Positive Ipswich touch test, detecting positive 9.9 (5.9, 0.3 (0.2, 25–47
monofilament testing 16.7) 0.3)
EBM Box 55.1 The diabetic foot
Insensate to the 5.07 monofilament, predicting 2.7 (2, 3.6) 0.5 (0.4, 2–29
future foot ulceration 0.6)
Ulcer area ≥2 cm2, detecting osteomyelitis 2.2 (0.4, 0.6 (0.2, 52–68
CI) CI) (Range)
11.4) 2.4)
CI) CI) (Range)
Ulcer area ≥3 cm2, detecting osteomyelitis 3.5 (1.6, 0.3 (0.1, 52
7.7) 0.6)
Ulcer area ≥4 cm2, detecting osteomyelitis 7.3 (1.9, 0.4 (0.2, 52
28.3) 0.7)
Ulcer area ≥5 cm2, detecting osteomyelitis 11 (1.6, 0.5 (0.3, 52
77.8) 0.8)
Probe-to-bone positive, detecting osteomyelitis 6 (4, 8.9) 0.2 (0.1, 12–80
0.4)
Ulcer depth >3 mm or bone exposed, detecting 3.9 (1.9, 0.3 (0.2, 63–68
osteomyelitis 8.1) 0.6)
Erythema, swelling, purulence, detecting 1.8 (0.9, 0.8 (0.6, 1) 63–68
osteomyelitis 3.8)
0 findings, predicting nonhealing wound 0.5 (0.4, … 53
0.5)
0.8)
1.8)
3.8)
Chapter 56 - Edema and deep vein thrombosis

CI) CI) (Range)
Active cancer, detecting proximal leg DVT 2.9 (2.4, 0.9 (0.8, 13–34
3.6) 0.9)
Recent immobilization, detecting proximal leg 1.6 (1.3, 0.9 (0.8, 13–34
DVT 2.1) 0.9)
Recent surgery, detecting proximal leg DVT 1.6 (1.3, 0.9 (0.9, 1) 13–29
1.9)
Modified Wells ≤0, detecting proximal DVT 0.3 (0.1, … 15–18
0.6)
Modified Wells 1–2, detecting proximal DVT 1 (0.9, 1.2) … 15–18
Modified Wells ≥3, detecting proximal DVT 3.9 (3.2, … 15–18
4.8)
Modified Wells ≥2, detecting proximal DVT 1.8 (1.4, 0.3 (0.2, 15–36
2.5) 0.4)
EBM Box 56.1 Leg DVT
Any calf or ankle swelling 1.2 (1.1, 0.7 (0.6, 25–54
1.3) 0.8)
Asymmetric calf swelling, ≥2 cm difference 2.1 (1.8, 0.5 (0.4, 13–16
2.5) 0.7)
Swelling of entire leg 1.5 (1.2, 0.8 (0.6, 22–34

CI) CI) (Range)
1.8) 0.9)
CI) CI) (Range)
Superficial venous dilation 1.6 (1.4, 0.9 (0.8, 22–44
1.9) 0.9)
Erythema 1 (0.6, 1.7) 1 (0.8, 1.2) 27–45
Superficial thrombophlebitis 0.9 (0.2, 1 (0.9, 1.1) 43
5.1)
Tenderness 1 (1, 1.1) 1 (0.9, 1.1) 22–54
Asymmetric skin coolness 1.2 (0.6, 0.9 (0.6, 46
2.2) 1.4)
Asymmetric skin warmth 1.4 (1.2, 0.7 (0.5, 27–45
1.7) 1.2)
Palpable cord 1.1 (0.7, 1 (0.9, 1.1) 27–34
1.6)
Homans sign 1.1 (0.9, 1 (0.9, 1.1) 27–58
1.3)
EBM Box 56.2 Leg DVT
Wells low probability 0.2 (0.2, … 6–43
0.3)
Wells moderate probability 1 (0.7, 1.3) … 6–39
Wells high probability 6.3 (4, … 6–39
10.1)
EBM Box 56.3 Arm DVT

CI) CI) (Range)
Constans score, 0 or 1 0.3 (0.1, … 25–35
0.8)
Constans score, 2 or 3 3 (1.9, 4.8) … 25–35
Chapter 57 Examination of the musculoskeletal system
Constant pain in low back and buttock, detecting 6.7 (2.4, 0.5 (0.3, 29
hip osteoarthritis 18.6) 0.8)
Pain in ipsilateral groin, detecting hip 3.6 (1.1, 0.8 (0.6, 1) 29
osteoarthritis 11.6)
Knee flexion <120 degrees, detecting knee 3.4 (1.5, 8) 0.9 (0.8, 1) 8
arthritis
Overall clinical impression, detecting ACL tear 49.6 (29.1, 0.1 (0, 0.2) 11–43
85)
Clinical impression medial meniscal injury, 3.6 (2.4, 0.1 (0.1, 19–69
detecting medial meniscal injury 5.4) 0.2)
Clinical impression lateral meniscal injury, 8.6 (4.9, 0.5 (0.4, 7–68
detecting lateral meniscal injury 15.4) 0.6)
EBM Box 57.1 Shoulder pain
Detecting acromioclavicular joint pain
Acromioclavicular joint tenderness 1.1 (0.9, 0.4 (0, 5.2) 74

CI) CI) (Range)
1.3)
CI) CI) (Range)
Tenderness with AC joint compression 1.6 (0.8, 3) 0.4 (0.2, 74
1.1)
Crossed body adduction causes pain 3.7 (2.9, 0.3 (0.2, 6
4.7) 0.5)
Detecting rotator cuff tendinitis
Neer impingement sign 1.6 (1.2, 0.5 (0.4, 28–90
2.3) 0.5)
Hawkins impingement sign 1.7 (1.2, 0.3 (0.2, 28–90
2.3) 0.5)
Neer or Hawkins impingement sign 1.6 (1.3, 2) 0.1 (0, 0.7) 28
Yergason sign 2.8 (1.2, 0.7 (0.6, 70
6.6) 0.9)
Speed test 1.9 (1.3, 0.7 (0.6, 65–70
2.8) 0.9)
Painful arc 2.9 (1.6, 0.5 (0.3, 65–90
5.3) 1.1)
Detecting rotator cuff tear
Age ≤39 years 0.1 (0.1, … 50
0.2)
Age 40–59 years 0.9 (0.7, … 50

CI) CI) (Range)
1.1)
CI) CI) (Range)
Age ≥60 years 3.2 (2.4, … 50
4.3)
Supraspinatus atrophy 2 (1.5, 2.7) 0.6 (0.5, 67
0.7)
Infraspinatus atrophy 2 (1.5, 2.7) 0.6 (0.5, 67
0.7)
Painful arc 1.6 (0.97, 0.5 (0.3, 38–67
2.8) 0.8)
Neer impingement sign 2.1 (1.3, 0.5 (0.3, 28–77
3.7) 0.8)
Hawkins impingement sign 1.7 (1.3, 0.7 (0.6, 28–77
2.3) 0.8)
Supraspinatus test causes pain 1.5 (1.1, 2) 0.5 (0.3, 24–86
0.8)
Supraspinatus weakness 2.1 (1.6, 0.4 (0.3, 23–86
2.7) 0.6)
Infraspinatus weakness 2.6 (1.5, 0.6 (0.4, 38–67
4.6) 0.9)
Dropped arm test 2.9 (2.1, 4) 0.9 (0.8, 1) 38–50
Palpable tear 10.2 (1.3, 0.1 (0, 0.2) 42–81

CI) CI) (Range)
80.9)
CI) CI) (Range)
EBM Box 57.2 Rotator cuff tear
3 findings (Murrell) 48 (6.7, … 50
344)
2 findings (Murrell) 4.9 (2.9, … 50
8.3)
1 finding (Murrell) 0.9 (0.7, … 50
1.1)
0 findings (Murrell) 0.02 (0, … 50
0.1)
3 findings (Park) 15.9 (5.9, … 44
43.1)
2 findings (Park) 3.6 (2.2, … 44
5.7)
1 finding (Park) 0.8 (0.6, … 44
1.1)
0 findings (Park) 0.2 (0.1, … 44
0.3)
EBM Box 57.3 Hip osteoarthritis
Squat causes pain in posterior hip 6.1 (1.3, 0.8 (0.6, 1) 29
28.9)
Abduction or adduction causes groin pain 5.7 (1.6, 0.7 (0.5, 1) 29

CI) CI) (Range)
19.8)
CI) CI) (Range)
Active hip flexion causes lateral hip pain 3.6 (1.5, 9) 0.6 (0.4, 1) 29
Active hip extension causes hip pain 2.7 (1.3, 0.6 (0.4, 29
5.3) 0.9)
Passive internal rotation ≤25 degrees 1.9 (1.3, 0.4 (0.2, 29
2.9) 0.9)
Passive internal rotation ≤15 degrees 9.9 (5.5, 0.6 (0.5, 6
17.7) 0.8)
EBM Box 57.4 Knee osteoarthritis
Stiffness <30 minutes 3 (2.1, 4.4) 0.2 (0.1, 55
0.3)
Crepitus, passive motion 2.1 (1.7, 0.2 (0.1, 52
2.7) 0.3)
Bony enlargement 11.8 (4.9, 0.5 (0.4, 52
28.2) 0.6)
Palpable increase in temperature 0.3 (0.2, 1.6 (1.4, 2) 52
0.5)
Valgus deformity 1.4 (0.8, 0.9 (0.8, 1) 52
2.4)
Varus deformity 3.4 (1.6, 0.8 (0.7, 52
7.6) 0.9)
At least 3 out of 6 findings 3.1 (2.3, 0.1 (0, 0.1) 55

CI) CI) (Range)
4.1)
CI) CI) (Range)
EBM Box 57.5 Knee fracture
Age ≥55 years 3 (1.6, 5.3) 0.7 (0.5, 1) 6–9
Joint effusion 2.5 (2, 3) 0.5 (0.3, 6–9
0.7)
Ecchymosis 2.2 (0.9, 0.9 (0.7, 9
5.3) 1.1)
Cannot flex beyond 90° 2.9 (2.5, 0.5 (0.4, 6–9
3.4) 0.7)
Cannot flex beyond 60° 4.7 (3.8, 0.6 (0.5, 6
5.9) 0.7)
Isolated tenderness of patella 2.2 (1.6, 0.8 (0.8, 6–9
2.9) 0.9)
Tenderness at head of fibula 3.4 (2.5, 0.9 (0.8, 1) 6–9
4.7)
Inability to bear weight, immediately and in 3.6 (3, 4.3) 0.6 (0.5, 6–9
emergency department 0.7)
Ottawa knee rule positive 1.7 (1.4, 2) 0.1 (0, 0.2) 6–12
EBM Box 57.6 Ligament and meniscal injuries
Anterior drawer sign, detecting ACL tear 12.2 (6.1, 0.4 (0.3, 26–76
24.2) 0.5)
Lachman sign, detecting acl tear 20.5 (7.4, 0.2 (0.1, 26–76
CI) CI) (Range)
56.3) 0.3)
CI) CI) (Range)
Pivot shift sign, detecting acl tear 8.2 (4.2, 0.7 (0.6, 26–76
16) 0.9)
Posterior drawer sign, detecting pcl tear 97.8 (24.2, 0.1 (0, 0.5) 3–13
396)
McMurray sign, detecting meniscal injury 3.6 (2.5, 0.6 (0.5, 25–85
5.1) 0.7)
Joint line tenderness, detecting meniscal injury 1.9 (1.4, 0.4 (0.3, 21–81
2.6) 0.6)
Block to full extension, detecting meniscal injury 3.2 (1.8, 0.7 (0.5, 50
5.9) 0.8)
Pain on forced extension, detecting meniscal 1.6 (1.2, 0.7 (0.6, 50–81
injury 2.2) 0.9)
Valgus laxity, detecting medial collateral 7.7 (1.6, 0.2 (0.1, 22–44
ligament injury 37) 0.3)
Varus laxity, detecting lateral collateral ligament 16.2 (2.4, 0.8 (0.4, 1
injury 109) 1.3)
EBM Box 57.7 Ankle and midfoot fracture
Detecting ankle fracture
Tenderness over posterior lateral malleolus 2.4 (1.9, 0.4 (0.3, 10–14
2.8) 0.5)
Tenderness over posterior medial malleolus 4.8 (2.6, 9) 0.6 (0.6, 10–14
CI) CI) (Range)
0.7)
CI) CI) (Range)
Inability to bear weight immediately after injury 2.6 (2.2, 0.5 (0.4, 10–14
3.1) 0.6)
Inability to bear weight 4 steps in the emergency 2.5 (2.2, 0.3 (0.2, 10–14
room 2.8) 0.4)
Ottawa ankle rule 1.5 (1.3, 0.1 (0, 0.2) 9–34
1.7)
Detecting midfoot fracture
Tenderness at the base of the 5th metatarsal 2.9 (2.5, 0.1 (0.1, 12–14
3.3) 0.2)
Tenderness of navicular bone 0.4 (0.2, 1.1 (1, 1.2) 12–14
0.9)
Inability to bear weight immediately after injury 1 (0.5, 2.3) 1 (0.8, 1.3) 12–14
Inability to bear weight 4 steps in the emergency 1.1 (0.8, 0.9 (0.8, 12–14
room 1.4) 1.1)
Ottawa foot rule 2.1 (1.3, 0.1 (0, 0.2) 2–23
3.3)
EBM Box 57.8 Achilles tendon tear
Palpable gap in Achilles tendon 6.8 (2.3, 0.3 (0.2, 83
19.9) 0.4)
Calf squeeze test 13.5 (3.5, 0.05 (0, 0.1) 83

CI) CI) (Range)
51.2)
CI) CI) (Range)
Knee flexion test 6.2 (2.5, 0.1 (0.1, 73
15.4) 0.3)
Chapter 58 Visual field testing
Visual field defect, detecting focal cerebral 4.3 (1.1, 0.8 (0.7, 71–75
defect 17.6) 0.9)
EBM Box 58.1 Visual field defects
Confrontation technique, detecting anterior visual 5.7 (3.7, 0.7 (0.6, 26–85
field defects 8.7) 0.8)
Confrontation technique, detecting posterior 9.5 (4.5, 0.4 (0.3, 6–53
visual field defects 19.9) 0.6)
Asymmetric optokinetic nystagmus, detecting 5.7 (3.2, 0.1 (0, 0.3) 33
parietal lobe disease 10.1)
Associated hemiparesis or aphasia, detecting 18.3 (6, 0.1 (0, 0.7) 14
parietal lobe disease 56.2)
EBM Box 58.2 Visual field defects
Finger counting 54.4 (7.6, 0.7 (0.6, 45–64
388) 0.8)
Kinetic finger boundary 13.3 (5.9, 0.6 (0.6, 45–64
29.8) 0.7)
Description of face 26.4 (8.5, 0.6 (0.5, 45–64

CI) CI) (Range)
82.6) 0.7)
CI) CI) (Range)
Kinetic red boundary testing 13.6 (3.6, 0.4 (0.2, 45–64
50.7) 0.6)
Laser target testing 6.3 (3.4, 0.3 (0.2, 47
12) 0.5)
Red target comparison 6.2 (0.1, 0.6 (0.3, 45–64
314) 1.2)
Chapter 59 Nerves of the eye muscles
Periorbital emphysema (if face trauma), detecting 4.9 (2.7, 0.8 (0.7, 77
orbital fracture 8.8) 0.8)
Inferior orbital hypoesthesia (if face trauma), 3.5 (2.2, 0.8 (0.7, 77
detecting orbital fracture 5.4) 0.8)
Diplopia (if face trauma), detecting orbital 2.6 (1.9, 0.7 (0.7, 77
fracture 3.7) 0.8)
Positive upright-supine test, detecting skew 73.8 (4.4, 0.6 (0.5, 20
deviation 1227) 0.9)
Horizontal diplopia and esotropia, detecting VI 19.2 (4, 0.04 (0, 0.6) 29
palsy 91.8)
Horizontal diplopia and exotropia, detecting 68.4 (4.3, 0.1 (0, 1.4) 10
internuclear ophthalmoplegia 1091)

CI) CI) (Range)
Vertical diplopia, anisocoria, and ptosis, 7.4 (3.1, 0.1 (0, 1.2) 15
detecting III palsy 18.1)
Vertical diplopia and signs of orbitopathy, 68.4 (4.3, 0.1 (0, 1.4) 10
detecting orbital disease 1091)
Isolated vertical diplopia, detecting IV palsy 11.3 (3.3, 0.2 (0, 0.8) 20
38.7)
EBM Box 59.1 Ice pack test for myasthenia
Improvement in ptosis after application of ice 8.1 (5.3, 0.1 (0.1, 32–75
12.4) 0.3)
Improvement in diplopia and ophthalmoplegia 30.6 (7.7, 0.1 (0, 0.9) 18–50
after application of ice 123)
Chapter 60 Miscellaneous cranial nerves
Hutchinson sign in VZV, detecting ocular 4 (2.7, 5.7) 0.4 (0.3, 28–86
complications 0.7)
EBM Box 60.1 Aspiration after stroke
Abnormal voluntary cough 2.1 (1.5, 3) 0.7 (0.6, 12–71
0.8)
Dysphonia 1.5 (1.2, 0.5 (0.4, 12–71
1.9) 0.8)
Dysarthria 2 (1.4, 2.9) 0.5 (0.3, 12–68

CI) CI) (Range)
0.7)
CI) CI) (Range)
Drowsiness 3.6 (1.5, 0.6 (0.4, 12–42
8.7) 1.1)
Abnormal sensation face and tongue 0.5 (0.2, 1.5 (0.9, 46
1.2) 2.4)
Absent pharyngeal sensation 2.4 (1.6, 0.03 (0, 0.5) 42
3.6)
Tongue weakness 1.8 (1, 3.2) 0.6 (0.5, 18–30
0.9)
Bilateral cranial nerve signs 1.1 (0.8, 0.8 (0.4, 51–52
1.6) 1.6)
Abnormal gag reflex 1.4 (1.2, 0.6 (0.5, 19–71
1.7) 0.8)
Water swallow test 2.6 (1.9, 0.4 (0.3, 12–68
3.5) 0.6)
Oxygen desaturation 0–2 min after swallowing 3.5 (1.4, 0.4 (0.3, 28–64
9.2) 0.5)
Chapter 61 examination of motor system
Ipsilateral calf wasting, diagnosing lumbosacral 5.2 (1.3, 0.8 (0.6, 74
radiculopathy 20.8) 0.9)
EBM Box 61.1 Unilateral cerebral hemispheric disease
Hemianopia 4.3 (1.1, 0.8 (0.7, 71–75

CI) CI) (Range)
17.6) 0.9)
CI) CI) (Range)
Pronator drift 9.6 (5.4, 0.3 (0.2, 51–76
16.9) 0.7)
Arm rolling test 15.6 (5.8, 0.6 (0.4, 51–76
41.5) 0.8)
Index finger rolling test 6 (2, 18.5) 0.7 (0.6, 67–71
0.8)
Little finger rolling test 1.5 (0.1, 1 (0.9, 1.1) 58
15.2)
Finger tapping test 4.7 (2.1, 0.5 (0.3, 51–76
10.3) 0.8)
Foot tapping test 2 (0.6, 6.5) 0.9 (0.7, 67–71
1.1)
Hemisensory disturbance 12.3 (0.8, 0.7 (0.6, 76
196) 0.9)
Hyperreflexia 5.3 (3, 9.5) 0.6 (0.2, 51–71
1.5)
Babinski response 8.5 (1.7, 0.8 (0.6, 1) 67–76
43.3)
EBM Box 61.2 Localization of stroke
Aphasia, detecting anterior stroke 12.1 (5.5, 0.7 (0.5, 68–74

CI) CI) (Range)
26.7) 0.9)
CI) CI) (Range)
Conjugate gaze palsy, detecting anterior stroke 3.2 (2.3, 0.9 (0.8, 1) 68–74
4.3)
Ataxia, detecting posterior stroke 5.8 (4.2, 8) 0.7 (0.7, 26
0.8)
Horner syndrome, detecting posterior stroke 72 (4.3, 1 (0.9, 1) 26
1213)
Heterotropia, detecting posterior stroke 10 (4.2, 0.9 (0.9, 1) 26
23.6)
Nystagmus, detecting posterior stroke 14 (6.5, 0.9 (0.9, 26
30.4) 0.9)
Crossed motor paresis, detecting posterior stroke 24 (4.4, 1 (0.9, 1) 26
129.9)
Crossed sensory findings, detecting posterior 54.7 (3.2, 1 (0.9, 1) 26
stroke 938)
Chapter 62 Examination of the sensory system
Diminished pinprick sensation, detecting nerve 4.6 (2.4, 0.2 (0.1, 60
fiber density <8 epidermal nerve fibers/mm 8.6) 0.3)
Chapter 63 Examination of the reflexes
Diminished biceps or brachioradialis reflex, 14.2 (4.3, 0.5 (0.3, 19
detecting C6 radiculopathy 46.7) 0.8)
Diminished triceps reflex, detecting C7 3 (1.6, 5.6) 0.6 (0.3, 54–69

CI) CI) (Range)
radiculopathy 1.4)
Asymmetric quadriceps reflex, detecting L3 or 8.5 (5, 0.7 (0.6, 2–46
L4 radiculopathy 14.5) 0.8)
Abnormal medial hamstring reflex, detecting L5 6.2 (1.6, 0.5 (0.3, 58
root disease 24.2) 0.7)
Asymmetric Achilles reflex, detecting S1 2.7 (1.9, 0.5 (0.4, 20–66
Asymmetric Achilles reflex, detecting diabetic 2.8 (2.1, 0.1 (0.1, 39
neuropathy 3.8) 0.3)
Bulbocavernosus reflex in men, detecting S2-S4 13 (5.9, 0.3 (0.2, 27
lesion 28.9) 0.5)
Bulbocavernosus reflex in women, detecting S2- 2.7 (1.6, 0.6 (0.5, 22
S4 lesion 4.6) 0.9)
Babinski sign, detecting cervical myelopathy 24.8 (1.5, 0.6 (0.5, 52
402) 0.8)
Inverted supinator reflex, detecting cervical 1.7 (1.1, 0.5 (0.2, 52
myelopathy 2.5) 0.9)
Hoffman sign, detecting cervical myelopathy 1.7 (0.8, 0.6 (0.3, 31–52
3.3) 1.2)
CI) CI) (Range)
Palmomental reflex, detecting frontal lobe lesion 6.3 (2.2, 0.8 (0.7, 1) 14
on MRI 18.3)
Positive grasp reflex, detecting discrete lesion in 19.1 (5.9, 0.7 (0.4, 21–37
the frontal lobe, deep nuclei, or subcortical white 61.7) 1.2)
matter
Chapter 64 Disorders of nerve roots, plexuses, and peripheral nerves
Motor and sensory findings confined to C7-T1, 30.9 (2, 0.3 (0.2, 61
detecting malignant plexopathy 483.8) 0.5)
Horner syndrome, detecting malignant 4.1 (1.4, 0.5 (0.3, 61
plexopathy 12.2) 0.8)
Motor and sensory findings confined to C5C6, 8.8 (2.9, 0.2 (0.1, 39
detecting radiation plexopathy 26.4) 0.5)
Lymphedema of arm, detecting radiation 4.9 (2.1, 0.3 (0.2, 39
plexopathy 11.6) 0.6)
Weak hip abduction if foot drop, detecting 24 (3.5, 0.1 (0.1, 43
lumbosacral radiculopathy 165.8) 0.4)
Unilateral involvement, detecting malignant 4.5 (1.8, 0.1 (0, 0.4) 58
lumbosacral plexopathy 10.8)
Bilateral involvement, detecting radiation 7.5 (2.5, 0.2 (0.1, 42
lumbosacral plexopathy 22.2) 0.5)
EBM Box 64.1 Diagnosing cervical radiculopathy

CI) CI) (Range)
Weakness of any arm muscle 1.9 (1.4, 0.4 (0.3, 52
2.5) 0.6)
Reduced sensation in arm 0.7 (0.5, 1) 1.4 (1, 1.8) 52
Reduced biceps reflex 9.1 (1.2, 0.9 (0.8, 1) 52
69.4)
Reduced brachioradialis reflex 7.3 (0.9, 0.9 (0.9, 1) 52
56.8)
Reduced triceps reflex 2.3 (0.7, 7) 0.9 (0.9, 1) 52
Reduced biceps, triceps, or brachioradialis reflex 3.6 (1.4, 0.8 (0.7, 52
9.2) 0.9)
Spurling test 4.8 (2.8, 0.6 (0.4, 10–79
8.2) 0.8)
Rotation of neck to involved side <60 degrees 1.7 (1.3, 0.2 (0.1, 22
2.3) 0.9)
EBM Box 64.2 Localizing cervical radiculopathy
Weak elbow flexion, detecting C5 radiculopathy 5.3 (2.7, 0.2 (0, 2.5) 2
10.5)
Weak wrist extension, detecting C6 2.3 (1.1, 5) 0.8 (0.5, 19
radiculopathy 1.1)
Weak elbow extension, detecting C7 4 (1.8, 9.2) 0.4 (0.3, 69

CI) CI) (Range)
radiculopathy 0.6)
Weak finger flexion, detecting C8 radiculopathy 3.8 (1.7, 0.6 (0.3, 10
8.5) 1.1)
Sensory loss of thumb, detecting C6 8.5 (2.3, 0.7 (0.5, 1) 19
radiculopathy 31.1)
Sensory loss of middle finger, detecting C7 3.2 (0.2, 1 (0.9, 1) 69
radiculopathy 60.1)
Sensory loss of little finger, detecting C8 41.4 (2.1, 0.8 (0.6, 10
radiculopathy 807) 1.1)
Diminished biceps or brachioradialis reflex, 14.2 (4.3, 0.5 (0.3, 19
detecting C6 radiculopathy 46.7) 0.8)
Diminished triceps reflex, detecting C7 3 (1.6, 5.6) 0.6 (0.3, 54–69
radiculopathy 1.4)
EBM Box 64.3 Carpal tunnel syndrome
“Classic” or “probable” Katz hand diagram 2.4 (1.6, … 37
3.5)
“Unlikely” Katz hand diagram 0.2 (0, 0.7) … 37
Weak thumb abduction 1.8 (1.4, 0.6 (0.4, 50–74
2.3) 0.9)
Thenar atrophy 2.9 (1.1, 0.9 (0.8, 1) 35–74

CI) CI) (Range)
7.9)
CI) CI) (Range)
Hypalgesia 3.1 (2, 5.1) 0.7 (0.5, 35–62
1.1)
Diminished 2-point discrimination 2 (0.7, 5.3) 0.8 (0.5, 40–57
1.2)
Abnormal vibration sensation 1.6 (0.8, 3) 0.8 (0.4, 50–57
1.3)
Diminished monofilament sensation 1.2 (1, 1.5) 0.4 (0.1, 2) 53–56
Tinel sign 1.4 (1.2, 0.8 (0.6, 35–75
1.8) 0.9)
Phalen sign 1.4 (1.2, 0.6 (0.5, 35–88
1.7) 0.8)
Pressure provocation test 1.2 (0.8, 0.7 (0.4, 49–88
1.9) 1.2)
Square wrist ratio 2.7 (2.2, 0.5 (0.4, 60–62
3.4) 0.8)
Flick sign 5.5 (0.4, 0.3 (0, 2.8) 54–67
77.4)
EBM Box 64.4 Diagnosing lumbosacral radiculopathy
Weak ankle dorsiflexion 4.9 (1.9, 0.5 (0.4, 74
12.5) 0.7)
Ipsilateral calf wasting 5.2 (1.3, 0.8 (0.6, 74

CI) CI) (Range)
20.8) 0.9)
CI) CI) (Range)
Leg sensation abnormal 1.1 (0.9, 0.9 (0.8, 47–74
1.5) 1.1)
Abnormal ankle jerk 2.1 (1.4, 0.8 (0.7, 47–74
3.1) 0.9)
Straight-leg raising maneuver 1.5 (1.2, 0.4 (0.3, 47–87
1.9) 0.6)
Crossed straight-leg raising maneuver 3.4 (1.8, 0.8 (0.7, 55–87
6.4) 0.9)
EBM Box 64.5 Localizing lumbosacral radiculopathy
Weak knee extension, detecting L3 or L4 4 (2.2, 7.2) 0.6 (0.5, 25–63
radiculopathy 0.8)
Weak hallux extension, detecting L5 1.7 (1.2, 0.7 (0.5, 52–57
Weak ankle dorsiflexion, detecting L5 1.3 (0.9, 0.8 (0.6, 1) 52–58
radiculopathy 1.8)
Weak ankle plantarflexion, detecting S1 4.8 (0.4, 0.7 (0.6, 20–48
Ipsilateral calf wasting, detecting S1 2.4 (1.2, 0.7 (0.5, 48

CI) CI) (Range)
Sensory loss L5 distribution, detecting L5 3.1 (1.8, 0.8 (0.7, 52–58
Sensory loss S1 distribution, detecting S1 2.4 (1.3, 0.7 (0.6, 41–48
Asymmetric quadriceps reflex, detecting L3 or 8.5 (5, 0.7 (0.6, 2–46
Asymmetric medial hamstring reflex, detecting 6.2 (1.6, 0.5 (0.3, 58
Asymmetric Achilles reflex, detecting S1 2.7 (1.9, 0.5 (0.4, 20–66
Femoral stretch test, detecting L2–4 31.2 (1.9, 0.5 (0.3, 46
radiculopathy 499) 0.7)
Chapter 66 Tremor and Parkinson disease
Feet suddenly freezing in doorway, detecting 4.4 (1.5, 0.7 (0.5, 1) 28–32
Parkinson disease 12.4)
Voice becoming softer, detecting Parkinson 3.2 (1.8, 0.5 (0.1, 28–32
disease 5.8) 1.9)
Micrographia, detecting Parkinson disease 2.7 (1.8, 4) 0.7 (0.3, 28–32
1.3)
CI) CI) (Range)
Able to continue riding bicycle after symptom 2.4 (1.3, 0.2 (0, 1.6) 29–41
onset, detecting Parkinson disease 4.5)
Acute onset parkinsonism, detecting vascular 21.9 (3, 0.7 (0.6, 24–58
parkinsonism 161.8) 0.9)
EBM Box 66.1 Suspected Parkinson disease
Diagnosing Parkinson disease
Unable to perform perfect 10 tandem steps 0.2 (0.1, 4.6 (3.1, 28–63
0.5) 6.8)
Asymmetric arm swing 2.7 (1.2, 0.5 (0.4, 74
6.4) 0.8)
Positive applause sign 0.3 (0.2, 2.4 (1.8, 29–82
0.5) 3.1)
3 of 3 cardinal features present 2.2 (1.2, 0.5 (0.3, 76
4.2) 0.7)
3 of 3 cardinal features, asymmetry 4.1 (1.7, 0.4 (0.3, 76
10.2) 0.6)
Good response to levodopa 4.1 (1.1, 0.2 (0.1, 38–40
15.7) 0.2)
Detecting multisystem atrophy
Rapid progression 2.5 (1.6, 0.6 (0.4, 20–55

CI) CI) (Range)
4.1) 0.8)
CI) CI) (Range)
Absence of tremor 1.4 (1, 2) 0.7 (0.5, 15–55
1.1)
Speech and/or bulbar signs 4.1 (2.7, 0.2 (0.1, 28
6.1) 0.4)
Autonomic dysfunction 4.3 (2.3, 0.3 (0.2, 15–55
7.8) 0.4)
Cerebellar signs 6.6 (2.9, 0.6 (0.4, 15–80
15) 0.8)
Pyramidal tract signs 3 (1.3, 7.1) 0.7 (0.6, 15–80
0.9)
Dementia 0.3 (0.2, 1.9 (1.5, 15–27
0.6) 2.4)
Diagnosing progressive supranuclear palsy
Downgaze palsy and early postural instability 9.5 (3, 0.6 (0.6, 29–68
29.8) 0.7)
Detecting vascular parkinsonism
Pyramidal tract signs 16.2 (8.2, 0.5 (0.4, 20–58
32.2) 0.7)
Lower body parkinsonism 6.1 (4.3, 0.4 (0.3, 20–58
8.7) 0.5)
Chapter 67 Hemorrhagic vs. ischemic stroke

CI) CI) (Range)
Seizures at onset 4.7 (1.6, 0.9 (0.9, 1) 12–39
14.1)
Vomiting 3 (1.7, 5.5) 0.7 (0.6, 16–46
0.9)
Severe headache 2.9 (1.7, 0.7 (0.6, 12–46
4.8) 0.8)
Loss of consciousness 2.6 (1.6, 0.7 (0.5, 43
4.2) 0.8)
Previous TIA 0.3 (0.2, 1.2 (1.1, 12–17
0.7) 1.3)
EBM Box 67.1 Hemorrhagic stroke
Systolic BP >220 mm Hg 4 (1.1, 0.9 (0.7, 13
15.4) 1.1)
Systolic BP <160 mm Hg 0.4 (0.3, 1.9 (1.3, 35–43
0.6) 2.8)
Mental status coma 6.3 (3.4, … 12–48
11.7)
Mental status drowsy 1.7 (1.2, … 12–48
2.4)
Mental status alert 0.5 (0.3, … 16–48

CI) CI) (Range)
0.7)
CI) CI) (Range)
Neurologic deterioration during first 3 hours 5.8 (4.3, 0.2 (0.2, 18
7.8) 0.4)
Kernig or Brudzinski sign 2.9 (0.6, 1 (0.9, 1.1) 18–46
14.1)
Neck stiffness 5.4 (2.5, 0.7 (0.7, 18–59
11.3) 0.9)
Babinski present, bilateral toes 2.4 (1.6, … 17–43
3.6)
Babinski present, single toe 1 (0.9, 1.2) … 17–43
Babinski absent both toes 0.5 (0.3, … 17–43
0.9)
Deviation of eyes 1.9 (1.6, 0.7 (0.5, 15–17
2.3) 0.9)
Hemiparesis 0.9 (0.8, 1.3 (1, 1.7) 12–31
1.1)
Aphasia 1.1 (0.9, 1 (0.9, 1) 14–53
1.3)
Hemisensory disturbance 1.3 (1.2, 0.8 (0.7, 12–17
1.4) 1.1)
Hemianopia 1.3 (1.1, 0.9 (0.8, 1) 16

CI) CI) (Range)
1.6)
CI) CI) (Range)
Ataxia 0.7 (0.5, 1) 1.1 (1, 1.1) 16
Cervical bruit 0.1 (0, 0.4) 1.1 (1, 1.3) 16–43
Atrial fibrillation, ECG 0.3 (0.1, 1.3 (1.1, 12–44
0.5) 1.4)
EBM Box 67.2 Hemorrhagic stroke
Siriraj score “hemorrhage” (>1) 5.7 (4.5, … 13–69
7.2)
Siriraj score “uncertain (–1 to 1) 1 (0.9, 1.2) … 13–69
Siriraj score “infarction (<–1) 0.3 (0.2, … 13–69
0.4)
Chapter 68 Acute vertigo
Head impulse test positive (corrective saccades), 6.7 (3.7, 0.6 (0.5, 19–52
detecting abnormal caloric testing 12.1) 0.8)
Ophthalmoparesis, detecting stroke if dizzy 70 (8, 615) 0.9 (0.8, 1) 5
Limb ataxia, detecting stroke if dizzy 23.9 (2, 0.8 (0.7, 5–11
286) 0.9)
Dysarthria, detecting stroke if dizzy 20.6 (6.5, 0.7 (0.5, 5–8
65.8) 1.2)
Facial droop, detecting stroke if dizzy 18.8 (2, 0.6 (0.3, 5–8
174.8) 1.3)
Visual field defect, detecting stroke if dizzy 17.5 (1.1, 1 (0.9, 1) 5

CI) CI) (Range)
276)
CI) CI) (Range)
Focal weakness, detecting stroke if dizzy 8.6 (3.5, 0.7 (0.6, 3–30
21.3) 0.8)
Focal sensory disturbance, detecting stroke if 7 (2.4, 0.8 (0.7, 3–5
dizzy 20.1) 1.1)
Gait abnormality, detecting stroke if dizziness 4.5 (2.7, 0.4 (0.1, 3–5
7.5) 1.8)
Acute infarct on MRI DWI, detecting ischemic 44.2 (2.8, 0.2 (0.1, 75
stroke 690) 0.3)
EBM Box 68.1 Acute vertigo, detecting ischemic stroke
Severe truncal ataxia 17.9 (1.1, 0.7 (0.6, 75
283) 0.8)
Skew deviation present 7.1 (3.5, 0.6 (0.5, 37–73
14.2) 0.8)
Saccadic “smooth” pursuit 4.6 (2.5, 0.2 (0.1, 50–52
8.4) 0.5)
Direction-changing nystagmus 8.4 (1.9, 0.6 (0.4, 37–75
36.9) 0.8)
Normal head impulse test (i.e., no corrective 10.8 (4.3, 0.2 (0.1, 37–75
saccade) 27.2) 0.4)
Combined findings, 1 or more 13.6 (6.8, 0.02 (0, 0.1) 37–75

CI) CI) (Range)
27.1)
CI) CI) (Range)
Chapter 69 Nonorganic neurologic disorders
Knee-up test positive, detecting postoperative 462 (65, 0.1 (0, 0.4) 3
motor deficit 3298)
EBM Box 69.1 Nonorganic neurologic disease
Chair test positive 17 (1.1, 0.2 (0, 0.7) 50
257)
Knee-lift test positive 7.1 (1.6, 0.04 (0, 0.6) 58
31.5)
Drift without pronation 11.4 (3.5, 0.02 (0, 0.3) 48
37.3)
Hoover sign positive 42 (8.4, 0.3 (0.1, 6–49
210) 0.7)
Chapter 70 Examination of patients in the ICU
Pulse pressure increase ≥9%–12% (only patients 9.3 (3.1, 0.1 (0, 0.5) 33
with CVP increment after leg elevation), 27.8)
detecting patients who respond to fluid challenge
Prolonged capillary refill time (after fluid 10.5 (2.8, 0.6 (0.4, 1) 14
resuscitation), predicting hospital mortality 38.8)
Prolonged capillary refill time (before fluid 1.6 (0.8, 0.7 (0.4, 14
resuscitation), predicting hospital mortality 3.3) 1.3)
Mottling diminishes during hospitalization, 0.2 (0.1, 3.8 (1.4, 66

CI) CI) (Range)
predicting hospital mortality 0.5) 10.4)
EBM Box 70.1 Examination in the ICU
MEWS = 0, predicting hospital death 0.3 (0.2, 1.4 (1, 1.9) 9–14
0.4)
MEWS ≥5, predicting hospital death 4.8 (3.2, 0.6 (0.5, 1–15
7.2) 0.7)
Warms hands, detecting septic shock if 2.7 (1.6, 0.2 (0.1, 54
hypotension 4.5) 0.4)
Bounding pulses, detecting septic shock if 2.4 (1.3, 0.5 (0.3, 54
Elevated neck veins, detecting cardiogenic shock 4 (2.2, 7.1) 0.2 (0.1, 26
if hypotension 0.6)
Lung crackles, detecting cardiogenic shock if 1.9 (1.1, 0.6 (0.4, 26
Elevated neck veins and crackles, detecting 56.4 (3.5, 0.5 (0.3, 26
cardiogenic shock if hypotension 916) 0.7)
Pulse pressure increase ≥9%–12%, detecting 3.9 (2.6, 0.5 (0.4, 41–68
patients who respond to fluid challenge 5.8) 0.6)
Asynchronous breathing during COPD 3.2 (1.3, 0.5 (0.2, 1) 31
exacerbation, predicting intubation or death 7.8)
Asymmetric breath sounds, detecting 12.8 (5.8, 0.5 (0.3, 5–62

CI) CI) (Range)
endobronchial intubation 28.4) 0.8)
Diminished breath sounds in patients with 3 (1.5, 6) 0.7 (0.6, 26–48
ARDS, detecting underlying pleural effusion 0.9)
Anisocoria in patients with coma, detecting 9 (2.8, 0.6 (0.5, 40
structural intracranial lesion 28.8) 0.8)
Neck stiffness in patients with stroke, detecting 5.4 (2.5, 0.7 (0.7, 18–59
hemorrhagic stroke 11.3) 0.9)
EBM Box 70.2 Hypoperfusion in ICU patients
Cool extremities in ICU patients, detecting low 3.7 (2.1, 0.8 (0.8, 55
Cool extremities in septic ICU patients, detecting 5.2 (2.3, 0.7 (0.6, 47
low cardiac index 12.1) 0.9)
index 0.8)
index 3.4)
All 3 findings present, detecting low cardiac 7.5 (2.2, … 8
index 25.3)
Capillary refill time ≥5 sec, detecting low cardiac 1.6 (1.2, 0.9 (0.8, 1) 36
output 2.2)
Limb is cool or capillary refill time >4.5 sec, 2.2 (1.6, 3) 0.5 (0.4, 50
CI) CI) (Range)
detecting elevated lactate 0.7)
Limb is cool or capillary refill time >4.5 sec, 2.6 (1.9, 0.3 (0.2, 50
predicting multiorgan dysfunction 3.5) 0.5)
Capillary refill time ≥5 sec, predicting major 12.1 (5.4, 0.2 (0.1, 17
postoperative complications 27.1) 0.5)
Capillary refill time ≥5 sec, predicting mortality 4.6 (1.7, 0.6 (0.4, 37
if septic shock 12.8) 0.9)
Knee mottling, predicting mortality if septic 10.2 (3.2, 0.8 (0.6, 1) 11–52
shock 32)
AAI, Ankle/arm index; ACL, anterior cruciate ligament; ACTH, adrenocorticotropic hormone;
ALS, amyotrophic lateral sclerosis; ARDS, acute respiratory distress syndrome; AV,
atrioventricular; BMI, body mass index; BNP, brain-type natriuretic peptide; BP, blood pressure;
CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; CSF,
cerebrospinal fluid; CT, computed tomography; CVP, central venous pressure; CXR, chest
radiograph; DP, dorsalis pedis; DVT, deep vein thrombosis; DWI, diffusion-weighted image;
ECG, electrocardiogram; EF, ejection fraction; FUO, fever of unknown origin; HIV, human
immunodeficiency virus; ICU, intensive care unit; LLSB, left lower sternal border; LVH, left
ventricular hypertrophy; MCL, midclavicular line; MEWS, modified early warning system; MRI,
magnetic resonance imaging; MVP, mitral valve prolapse; PCL, posterior cruciate ligament; PR,
pulmonic regurgitation; PT, posterior tibialis; RV, right ventricular; TIA, transient ischemic
attack; UGI, upper gastrointestinal; VZV, varicella-zoster virus; WBC, white blood cells.

78 ch071 633 670 9780323754835

Uploaded by

Copyright:

Available Formats

You might also like

78 ch071 633 670 9780323754835

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

78 ch071 633 670 9780323754835

Uploaded by

Copyright:

Available Formats

Appendix

Appendix: Likelihood Ratios, Confidence Intervals, and Pretest Probability

discuss its significance.

Appendix Table 1 Likelihood Ratios, Confidence Intervals, and Pretest Probability

LR (95% LR (95% Probability

CI) CI) (Range)

EBM Box 6.1 Dementia and delirium

Abnormal clock drawing test 4 (2.7, 5.9) 0.5 (0.4, 22–73

Mini-Cog score 2 or less 4.5 (2.7, 0.1 (0.1, 3–52

Mini-mental status 23 or less 7.8 (6, 0.2 (0.2, 4–77

Mini-mental status 20 or less 14.4 (8, … 9–35

Mini-mental status 21–25 2.1 (1.7, … 14–35

Mini-mental status 26 or more 0.1 (0.1, … 14–77

Confusion assessment method 11.5 (7.2, 0.2 (0.1, 14–64

Chapter 7 Stance and gait

gluteus medius tear 9.1)

Hip abductor weakness, detecting lumbosacral 24 (3.5, 0.1 (0.1, 43

radiculopathy if foot drop 165.8) 0.4)

LR (95% LR (95% Probability

CI) CI) (Range)

plus disorder if parkinsonism 11.9) 0.3)

Timed-up-and-go test >16 s, detecting Parkinson- 5.6 (1.5, 0.4 (0.2, 72

plus disorder 21) 0.6)

EBM BOX 7.1 Gait abnormalities

if parkinsonism 6.8) 0.5)

Any gait or balance disorder, detecting 0.2 (0.1, 3.4 (1.9, 75

Alzheimer dementia 0.3) 5.8)

or Parkinson disease with dementia 18.1) 0.4)

Frontal gait, detecting vascular dementia 6.1 (3.2, 0.5 (0.3, 25

EBM Box 7.2 Predicting falls

LR (95% LR (95% Probability

CI) CI) (Range)

Palmomental reflex present 2.8 (1.7, 0.8 (0.7, 32

for 10 seconds 9.8)

Failure in tandem walk (>2 errors) 1.7 (1.5, 2) 0.7 (0.6, 19

Stops walking when talking 3 (1.3, 6.8) 0.8 (0.7, 1) 36–48

Timed up and go <15 sec 0.1 (0, 0.3) … 53

Timed up and go 15–35 sec 1.1 (0.9, … 53

Timed up and go ≥35 sec 2.6 (1.4, … 53

Caput medusa, detecting varices 1.5 (0.1, 1 (0.9, 1.1) 58

Spider angiomas, detecting varices 1.2 (0.9, 0.9 (0.8, 13–46

Jaundice, detecting varices 1.1 (0.5, 1 (0.8, 1.2) 13

Hepatomegaly, detecting varices 0.5 (0.1, 1.1 (1, 1.3) 13

LR (95% LR (95% Probability

CI) CI) (Range)

LR (95% LR (95% Probability

CI) CI) (Range)

Ascites, detecting varices 1.5 (1.2, 2) 0.7 (0.6, 13–58

Encephalopathy, detecting varices 1.3 (1.1, 0.9 (0.8, 1) 13–58

Dyspnea, detecting hepatopulmonary syndrome 3.3 (2.1, 0.5 (0.4, 14–37

Platypnea, detecting hepatopulmonary syndrome 10.6 (4.4, 0.4 (0.2, 26

Child class C cirrhosis, detecting 2.2 (1.2, 0.5 (0.3, 14–34

hepatopulmonary syndrome 4.1) 0.7)

EBM Box 8.1 Hepatocellular jaundice

Weight loss 0.8 (0.2, 1.3 (0.5, 65–67

Spider angiomas 4.7 (1, 0.6 (0.5, 65–67

Palmar erythema 9.8 (1.4, 0.5 (0.4, 67

Dilated abdominal veins 17.5 (1.1, 0.6 (0.5, 67