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October 24/31, 2001

Clinical Description of Nail Clubbing—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(16):1972-1973. doi:10.1001/jama.286.16.1969

In Reply: Although we agree with Dr Scharer that the terms used to describe clubbing are not standardized, it was not our intention to propose an ordinal grading system for clubbing. The purpose of our article was to review and synthesize the available evidence that might assist clinicians in establishing the presence of clubbing in individual patients using quantitative techniques, such as measurement of the nailfold angles and phalangeal depth ratio. Since the digital abnormalities in patients with "early" or "mild" clubbing can be subtle, we felt that these quantitative techniques would be most useful in these patients. Although systems that grade clubbing have been proposed,1,2 we were unable to identify any studies that linked the various grades of clubbing (eg, I through IV) to numerical cutpoints for the nailfold angles or phalangeal depth ratios.

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