Bohadana A B, Coimbra F T, Santiago J R
Respiration. 1986;50(3):218-25. doi: 10.1159/000194929.
Auscultatory percussion is a new method of physical examination developed by Guarino [Lancet i: 1332-1334, 1980]. It consists in tapping lightly the manubrium sterni with the distal phalanx of the middle finger while listening over the chest wall posteriorly with a stethoscope; a decrease in sound intensity is usually attributed to lung abnormalities. The aim of our study was to assess the validity of the method as compared to classical percussion, a point not entirely clear in the original study. Two observers independently examined 281 unselected patients (170 men; 111 women) referred for chest X-ray studies. Roentgenographic analysis, carried out by a third observer, revealed 12 categories of abnormalities in 96 patients. The validity of auscultatory and conventional percussion was calculated by taking the product of sensitivity and specificity of each method. For both observers and both methods, the values of this index were always found to be below 0.25, indicating that the results can be explained entirely by chance. When the roentgenographic category was taken into account, both methods of percussion were valid only to detect large pleural effusions. Auscultatory percussion failed completely to detect many other abnormalities including solitary nodules less than 6 cm in diameter. There is no single hypothesis to explain these results. Various possibilities are discussed.
听诊叩诊是瓜里诺发明的一种新的体格检查方法[《柳叶刀》i：1332 - 1334，1980年]。该方法是用中指远端指骨轻叩胸骨柄，同时用听诊器在胸壁后侧听诊；声音强度降低通常归因于肺部异常。我们研究的目的是评估该方法与传统叩诊相比的有效性，这一点在原研究中并不完全明确。两名观察者独立检查了281例因胸部X线检查而转诊的未经过筛选的患者（170名男性；111名女性）。由第三名观察者进行的X线分析显示，96例患者存在12种异常情况。通过计算每种方法的敏感性和特异性的乘积来确定听诊叩诊和传统叩诊的有效性。对于两名观察者和两种方法，该指标的值均始终低于0.25，这表明结果完全可能是偶然因素造成的。当考虑X线类别时，两种叩诊方法仅在检测大量胸腔积液时有效。听诊叩诊完全无法检测出许多其他异常情况，包括直径小于6厘米的孤立结节。目前尚无单一假说来解释这些结果。本文讨论了各种可能性。
