Chest
Clinical Investigations: CardiologyAnalysis of Physician Ability in the Measurement of Pulsus Paradoxus by Sphygmomanometry
Section snippets
Study Design
Physicians’ ability to accurately measure experimentally induced PP was assessed in a single reference subject. Attending-level physicians from emergency and critical care disciplines served as examiners who were self-selected based on subjective ability to measure PP. The study was conducted in a quiet laboratory setting, and the examiners were blinded to degree of PP. The reference subject (R.D.) was trained to generate incremental and predetermined degrees of PP by self-measured inspiratory
Results
A total of 19 examiners were used in this study; all were board certified in their respective disciplines of emergency medicine (n = 12), pediatric emergency medicine (n = 5), and pulmonary medicine/intensivists (n = 2). The combined level of experience for examiners was 9.2 ± 7.4 SD years since the end of postgraduate medical training, with two of the authors (D.S. and A.M.) serving as examiners. Across all examiners, the test subject generated values (mean ± SD) of PPt as follows: 13.7 ± 2.2,
Discussion
A limitation of our study is that the examining physicians did not practice their skill in determining PP prior to measurement. However, asking emergency physicians and critical care specialists who feel comfortable measuring PP to do so in an ad hoc manner is in keeping with clinical reality. Physicians are unable to “practice” this element of physical examination unless provided with some objective criterion that presently does not exist. There were no attempted measurements of physiologic PP
ACKNOWLEDGMENTS
We wish to thank Constantine Gatsonis, PhD, for his input.
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