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May 4, 1994

Accuracy of Precordial Percussion and Palpation-Reply

Author Affiliations

University of Illinois College of Medicine Chicago

JAMA. 1994;271(17):1319. doi:10.1001/jama.1994.03510410030020

In Reply.  — We agree with Dr Spodick that our concordance estimate for percussion was based on a small number of observations. The concordance κ for percussion was 0.57, representing moderate interobserver agreement.1 However, the 95% confidence interval for κ ranged from 0.18 (slight agreement) to 0.96 (almost perfect agreement).1 Further studies with larger numbers of observations will be necessary to estimate κ more precisely. In separate observations on 60 hospitalized patients, we compared the precordial percussion results of two medical residents with those of one of the investigators on each patient. A total of nine different residents were involved in measuring cardiac size during the observational period. We found that the percussion results of all three examiners generally agreed to within 0.2 to 0.7 cm (S.L.W., unpublished data, December 1993). Nevertheless, as suggested by Spodick, additional studies with multiple observers will be required to assess the generalizability

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