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Likelihood Ratio (LR) in Emergency Medicine

10/11/2012

Pleuritic pain and radio-occult lesion

Clinical Scenario

A 33 y/o woman, comes to the ED because of a sudden emithorax pain localized on the left in basal region. The pain is described as stabbing, well localised, it worsen with inspirium …a pleuritic pain, no cough, no fever, not hemoptysis. She smokes, she does not take any medication. Chest x ray is normal. 


Is it a wall chest pain or there migth be something else? 













Conclusion 

In the presence of pleuritic pain the negative predictive value of a negative chest x ray is well known so we are not going to discuss this.
As you easily can see from the images, there is not a clinical sign that can reduce or increase the probability to find a radio-occult lesion in patient with pleuritic pain, it sounds frightful because it might means that we have to performe a thorax CT to every patient compleining of  pleuritic pain…

Will we find the answer in blood test?



NB you might have been upseted by the positive LR of hemoptysis, it is not a writing mistake, it is very intresting because it shows, once more, how LR is much more real than sensitivity and specificity alone.
In this case specificity is very high 96,5%, so why this sign has not weight? What about “Spin”? The same study showes a sensitivity of 3% so low that the positive LR is lower than 1 despite the high specifity!



Bibliography 

American Journal of Emergency Medicine (2012) 30, 317–324 
A comparison of different diagnostic tests in the bedside evaluation of pleuritic pain in the ED 
Giovanni Volpicelli M et al.



Ilenia Spallino

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