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08/19/2011 - orthopnea

posted Sep 28, 2011, 5:17 PM by Chief Resident   [ updated Sep 28, 2011, 5:18 PM by Purnema Madahar ]
In intake this morning, Michelle Cleeves asked:

Q: In a patient presenting with dyspnea, what's the sensitivity of orthopnea in the diagnosis of heart failure?
A: sensitivity 50%, specificity 77%; this results in a positive LR of 2.2, negative LR of 0.65

These numbers are from the attached Rational Clinical Exam paper that included 18 studies that evaluated the role of the clinical examination in patients with undifferentiated dyspnea. The only symptom that trumps orthopnea's specificity is PND (84%); the symptom that has the highest sensitivity is DOE (84%). See the rest of the paper for more useful characteristics.