Author Affiliations: Departments of Medicine, Minneapolis Veterans Affairs Medical Center, University of Minnesota, Minneapolis (Dr Lederle), and Durham Veterans Affairs Medical Center, Duke University, Durham, NC (Dr Simel).
The Rational Clinical Examination Section Editors: David L.
Simel, MD, MHS, Durham Veterans Affairs Medical Center and Duke
University Medical Center, Durham, NC; Drummond Rennie, MD, Deputy
Editor (West), JAMA.
In the physical examination of abdominal aortic aneurysm
(AAA), the only maneuver of demonstrated value is abdominal palpation
to detect abnormal widening of the aortic pulsation. Palpation of AAA
appears to be safe and has not been reported to precipitate rupture.
The best evidence on the accuracy of abdominal palpation comes from 15
studies of patients not previously known to have AAA who were screened
with both abdominal palpation and ultrasound. When results from these
studies are pooled, the sensitivity of abdominal palpation increases
significantly with AAA diameter (P<.001), ranging from 29%
for AAAs of 3.0 to 3.9 cm to 50% for AAAs of 4.0 to 4.9 cm and 76%
for AAAs of 5.0 cm or greater. Positive and negative likelihood ratios
with 95% confidence intervals (CIs) using a cutoff point for AAAs of
3.0 cm or greater are 12.0 (95% CI, 7.4-19.5) and 0.72 (95% CI,
0.65-0.81), respectively, and for AAAs of 4.0 cm or greater are 15.6
(95% CI, 8.6-28.5) and 0.51 (95% CI, 0.38-0.67). The positive
predictive value of palpation for AAA of 3.0 cm or greater in these
studies was 43%. Limited data suggest that abdominal obesity decreases
the sensitivity of palpation. Abdominal palpation specifically directed
at measuring aortic width has moderate sensitivity for detecting an AAA
that would be large enough to be referred for surgery but cannot be
relied on to exclude AAA, especially if rupture is a
Lederle FA, Simel DL. Does This Patient Have Abdominal Aortic Aneurysm?. JAMA. 1999;281(1):77-82. doi:10.1001/jama.281.1.77