RT Journal
A1 Choudhry NK, Etchells EE
T1 DOes this patient have aortic regurgitation?
JF JAMA
JO JAMA
YR 1999
FD June 16
VO 281
IS 23
SP 2231
OP 2238
DO 10.1001/jama.281.23.2231
UL http://dx.doi.org/10.1001/jama.281.23.2231
AB Objective 
                  To review evidence as to the precision and accuracy
of clinical examination for aortic regurgitation (AR).Methods 
                  We conducted a structured MEDLINE search of
English-language articles (January 1966-July 1997), manually reviewed
all reference lists of potentially relevant articles, and contacted
authors of relevant studies for additional information. Each study
(n = 16) was independently reviewed by both authors and graded for
methodological quality.Results 
                  Most studies assessed cardiologists as examiners.
Cardiologists' precision for detecting diastolic murmurs was moderate
using audiotapes (κ=0.51) and was good in the
clinical setting (simple agreement, 94%). The most useful finding for
ruling in AR is the presence of an early diastolic murmur (positive
likelihood ratio [LR], 8.8-32.0 [95% confidence interval {CI},
2.8-32 to 16-63] for detecting mild or greater AR and 4.0-8.3 [95%
CI, 2.5-6.9 to 6.2-11] for detecting moderate or greater AR) (2 grade
A studies). The most useful finding for ruling out AR is the absence of
early diastolic murmur (negative LR, 0.2-0.3 [95% CI, 0.1-0.3 to
0.2-0.4) for mild or greater AR and 0.1 [95% CI, 0.0-0.3] for
moderate or greater AR) (2 grade A studies). Except for a test
evaluating the response to transient arterial occlusion (positive LR,
8.4 [95% CI, 1.3-81.0]; negative LR, 0.3 [95% CI, 0.1-0.8]), most
signs display poor sensitivity and specificity for AR.Conclusion 
                  Clinical examination by cardiologists is accurate for
detecting AR, but not enough is known about the examinations of
less-expert clinicians.