Physical examination before diagnostic ultrasonography: Alive and kicking or a relic of the past?
•Physical examination was omitted in over half of US referrals (55.6%).•Omission linked to lower reasoning and yield, but not significant after adjustment.•Skipping physical exam before US showed no clear effect on diagnostic outcomes. To investigate how often physicians perform physical examination...
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| Veröffentlicht in: | European journal of radiology Jg. 193; S. 112431 |
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| Abstract | •Physical examination was omitted in over half of US referrals (55.6%).•Omission linked to lower reasoning and yield, but not significant after adjustment.•Skipping physical exam before US showed no clear effect on diagnostic outcomes.
To investigate how often physicians perform physical examination prior to referring patients for diagnostic ultrasonography (US), and whether its omission affects clinical reasoning quality or diagnostic yield.
In this prospective study, patients undergoing diagnostic US at a tertiary care center (December 2024-April 2025) were asked whether their referring physician had performed a physical examination. Patient demographics, referring specialty, healthcare professional, US indication, and anatomical region were recorded. Clinical reasoning quality (0–100%) was defined as the alignment between clinically suspected and US findings. US outcomes were classified as positive, negative, or indeterminate. Associations with omission of physical examination were analyzed using multivariate regression.
Of 321 eligible patients, 302 were included (median age: 56 years; 48 % male). Physical examination was omitted in 168 cases (55.6 %). Omission was less likely in referrals from surgical specialties (odds ratio (OR) of 0.490, P = 0.032), family medicine (OR of 0.253, P = 0.016), and residents (OR 0.303, P < 0.001), as well as in cases of new complaints (OR of 0.226, P < 0.001) and head and neck US (OR of 0.261, P < 0.001). Omission was marginally associated with lower clinical reasoning scores on univariate analysis (P = 0.050), but not after adjustment. Of all exams, 51 % were positive. Omission of physical examination showed a trend toward lower diagnostic yield (P = 0.059), but was not significant after adjustment.
Physical examination was frequently omitted before US referral. While initially linked to reduced clinical reasoning and diagnostic yield, these associations did not remain significant after adjustment, suggesting no clear impact on diagnostic outcomes. |
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| AbstractList | •Physical examination was omitted in over half of US referrals (55.6%).•Omission linked to lower reasoning and yield, but not significant after adjustment.•Skipping physical exam before US showed no clear effect on diagnostic outcomes.
To investigate how often physicians perform physical examination prior to referring patients for diagnostic ultrasonography (US), and whether its omission affects clinical reasoning quality or diagnostic yield.
In this prospective study, patients undergoing diagnostic US at a tertiary care center (December 2024-April 2025) were asked whether their referring physician had performed a physical examination. Patient demographics, referring specialty, healthcare professional, US indication, and anatomical region were recorded. Clinical reasoning quality (0–100%) was defined as the alignment between clinically suspected and US findings. US outcomes were classified as positive, negative, or indeterminate. Associations with omission of physical examination were analyzed using multivariate regression.
Of 321 eligible patients, 302 were included (median age: 56 years; 48 % male). Physical examination was omitted in 168 cases (55.6 %). Omission was less likely in referrals from surgical specialties (odds ratio (OR) of 0.490, P = 0.032), family medicine (OR of 0.253, P = 0.016), and residents (OR 0.303, P < 0.001), as well as in cases of new complaints (OR of 0.226, P < 0.001) and head and neck US (OR of 0.261, P < 0.001). Omission was marginally associated with lower clinical reasoning scores on univariate analysis (P = 0.050), but not after adjustment. Of all exams, 51 % were positive. Omission of physical examination showed a trend toward lower diagnostic yield (P = 0.059), but was not significant after adjustment.
Physical examination was frequently omitted before US referral. While initially linked to reduced clinical reasoning and diagnostic yield, these associations did not remain significant after adjustment, suggesting no clear impact on diagnostic outcomes. To investigate how often physicians perform physical examination prior to referring patients for diagnostic ultrasonography (US), and whether its omission affects clinical reasoning quality or diagnostic yield.PURPOSETo investigate how often physicians perform physical examination prior to referring patients for diagnostic ultrasonography (US), and whether its omission affects clinical reasoning quality or diagnostic yield.In this prospective study, patients undergoing diagnostic US at a tertiary care center (December 2024-April 2025) were asked whether their referring physician had performed a physical examination. Patient demographics, referring specialty, healthcare professional, US indication, and anatomical region were recorded. Clinical reasoning quality (0-100%) was defined as the alignment between clinically suspected and US findings. US outcomes were classified as positive, negative, or indeterminate. Associations with omission of physical examination were analyzed using multivariate regression.METHODSIn this prospective study, patients undergoing diagnostic US at a tertiary care center (December 2024-April 2025) were asked whether their referring physician had performed a physical examination. Patient demographics, referring specialty, healthcare professional, US indication, and anatomical region were recorded. Clinical reasoning quality (0-100%) was defined as the alignment between clinically suspected and US findings. US outcomes were classified as positive, negative, or indeterminate. Associations with omission of physical examination were analyzed using multivariate regression.Of 321 eligible patients, 302 were included (median age: 56 years; 48 % male). Physical examination was omitted in 168 cases (55.6 %). Omission was less likely in referrals from surgical specialties (odds ratio (OR) of 0.490, P = 0.032), family medicine (OR of 0.253, P = 0.016), and residents (OR 0.303, P < 0.001), as well as in cases of new complaints (OR of 0.226, P < 0.001) and head and neck US (OR of 0.261, P < 0.001). Omission was marginally associated with lower clinical reasoning scores on univariate analysis (P = 0.050), but not after adjustment. Of all exams, 51 % were positive. Omission of physical examination showed a trend toward lower diagnostic yield (P = 0.059), but was not significant after adjustment.RESULTSOf 321 eligible patients, 302 were included (median age: 56 years; 48 % male). Physical examination was omitted in 168 cases (55.6 %). Omission was less likely in referrals from surgical specialties (odds ratio (OR) of 0.490, P = 0.032), family medicine (OR of 0.253, P = 0.016), and residents (OR 0.303, P < 0.001), as well as in cases of new complaints (OR of 0.226, P < 0.001) and head and neck US (OR of 0.261, P < 0.001). Omission was marginally associated with lower clinical reasoning scores on univariate analysis (P = 0.050), but not after adjustment. Of all exams, 51 % were positive. Omission of physical examination showed a trend toward lower diagnostic yield (P = 0.059), but was not significant after adjustment.Physical examination was frequently omitted before US referral. While initially linked to reduced clinical reasoning and diagnostic yield, these associations did not remain significant after adjustment, suggesting no clear impact on diagnostic outcomes.CONCLUSIONPhysical examination was frequently omitted before US referral. While initially linked to reduced clinical reasoning and diagnostic yield, these associations did not remain significant after adjustment, suggesting no clear impact on diagnostic outcomes. To investigate how often physicians perform physical examination prior to referring patients for diagnostic ultrasonography (US), and whether its omission affects clinical reasoning quality or diagnostic yield. In this prospective study, patients undergoing diagnostic US at a tertiary care center (December 2024-April 2025) were asked whether their referring physician had performed a physical examination. Patient demographics, referring specialty, healthcare professional, US indication, and anatomical region were recorded. Clinical reasoning quality (0-100%) was defined as the alignment between clinically suspected and US findings. US outcomes were classified as positive, negative, or indeterminate. Associations with omission of physical examination were analyzed using multivariate regression. Of 321 eligible patients, 302 were included (median age: 56 years; 48 % male). Physical examination was omitted in 168 cases (55.6 %). Omission was less likely in referrals from surgical specialties (odds ratio (OR) of 0.490, P = 0.032), family medicine (OR of 0.253, P = 0.016), and residents (OR 0.303, P < 0.001), as well as in cases of new complaints (OR of 0.226, P < 0.001) and head and neck US (OR of 0.261, P < 0.001). Omission was marginally associated with lower clinical reasoning scores on univariate analysis (P = 0.050), but not after adjustment. Of all exams, 51 % were positive. Omission of physical examination showed a trend toward lower diagnostic yield (P = 0.059), but was not significant after adjustment. Physical examination was frequently omitted before US referral. While initially linked to reduced clinical reasoning and diagnostic yield, these associations did not remain significant after adjustment, suggesting no clear impact on diagnostic outcomes. |
| ArticleNumber | 112431 |
| Author | Pavel, Andreea M. Kasalak, Ömer Kwee, Thomas C. Arita, Yuki |
| Author_xml | – sequence: 1 givenname: Andreea M. surname: Pavel fullname: Pavel, Andreea M. organization: Medical Imaging Center, Department of Radiology, University of Groningen, University Medical Center Groningen, the Netherlands – sequence: 2 givenname: Yuki surname: Arita fullname: Arita, Yuki organization: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA – sequence: 3 givenname: Ömer surname: Kasalak fullname: Kasalak, Ömer organization: Medical Imaging Center, Department of Radiology, University of Groningen, University Medical Center Groningen, the Netherlands – sequence: 4 givenname: Thomas C. orcidid: 0000-0001-9005-8529 surname: Kwee fullname: Kwee, Thomas C. email: t.c.kwee@umcg.nl organization: Medical Imaging Center, Department of Radiology, University of Groningen, University Medical Center Groningen, the Netherlands |
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| Cites_doi | 10.1136/bmjopen-2012-002257 10.1148/radiology.167.2.3282260 10.1097/00005373-200104000-00007 10.1007/s00330-022-09121-7 10.1097/ACM.0000000000000570 10.1016/j.amjmed.2020.01.015 10.1080/10401334.2020.1724792 10.1056/NEJMp068013 10.1186/s13054-019-2719-8 |
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| Keywords | Clinical reasoning Referral and Consultation CI Physical examination US Ultrasonography |
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| References | Peitzman, Cuddy (b0050) 2015; 90 Cox, Koster, Baron (b0025) 2020; 24 Jacobsen, Khiew, Murphy, Lane, Garibaldi (b0015) 2020; 32 Ersoydan, Yakar, Kasalak, Kwee (b0040) 2023; 33 Oliver, Hunter, Ikeda, Galletly (b0045) 2013; 3 Davis, Murray (b0005) 2016 Koratala (b0035) 2020; 133 Jauhar, The (b0010) 2006; 354 Rozycki, Pennington, Feliciano (b0030) 2001; 50 Filly (b0020) 1988; 167 Davis (10.1016/j.ejrad.2025.112431_b0005) 2016 Jauhar (10.1016/j.ejrad.2025.112431_b0010) 2006; 354 Oliver (10.1016/j.ejrad.2025.112431_b0045) 2013; 3 Jacobsen (10.1016/j.ejrad.2025.112431_b0015) 2020; 32 Cox (10.1016/j.ejrad.2025.112431_b0025) 2020; 24 Rozycki (10.1016/j.ejrad.2025.112431_b0030) 2001; 50 Koratala (10.1016/j.ejrad.2025.112431_b0035) 2020; 133 Ersoydan (10.1016/j.ejrad.2025.112431_b0040) 2023; 33 Filly (10.1016/j.ejrad.2025.112431_b0020) 1988; 167 Peitzman (10.1016/j.ejrad.2025.112431_b0050) 2015; 90 |
| References_xml | – volume: 3 year: 2013 ident: b0045 article-title: Junior doctor skill in the art of physical examination: a retrospective study of the medical admission note over four decades publication-title: BMJ Open – volume: 90 start-page: 209 year: 2015 end-page: 213 ident: b0050 article-title: Performance in physical examination on the USMLE step 2 clinical skills examination publication-title: Acad. Med. – start-page: 263 year: 2016 end-page: 277 ident: b0005 article-title: History and physical publication-title: Murray & Nadel's Textbook of Respiratory Medicine – volume: 32 start-page: 442 year: 2020 end-page: 448 ident: b0015 article-title: The modern physical exam - a transatlantic perspective from the resident level publication-title: Teach. Learn. Med. – volume: 167 start-page: 400 year: 1988 ident: b0020 article-title: Ultrasound: the stethoscope of the future, alas publication-title: Radiology – volume: 354 start-page: 548 year: 2006 end-page: 551 ident: b0010 article-title: demise of the physical exam publication-title: N. Engl. J. Med. – volume: 33 start-page: 1015 year: 2023 end-page: 1021 ident: b0040 article-title: Did medical doctors who order abdominal CT scans during on-call hours truly become worse at clinical reasoning? yes, they did publication-title: Eur. Radiol. – volume: 24 start-page: 14 year: 2020 ident: b0025 article-title: SICS Study Group. should the ultrasound probe replace your stethoscope? a SICS-I sub-study comparing lung ultrasound and pulmonary auscultation in the critically ill publication-title: Crit. Care – volume: 133 year: 2020 ident: b0035 article-title: Point of care ultrasonography enhanced physical examination: a nephrologist's perspective publication-title: Am. J. Med. – volume: 50 start-page: 636 year: 2001 end-page: 642 ident: b0030 article-title: Surgeon-performed ultrasound in the critical care setting: its use as an extension of the physical examination to detect pleural effusion publication-title: J. Trauma – volume: 3 year: 2013 ident: 10.1016/j.ejrad.2025.112431_b0045 article-title: Junior doctor skill in the art of physical examination: a retrospective study of the medical admission note over four decades publication-title: BMJ Open doi: 10.1136/bmjopen-2012-002257 – volume: 167 start-page: 400 year: 1988 ident: 10.1016/j.ejrad.2025.112431_b0020 article-title: Ultrasound: the stethoscope of the future, alas publication-title: Radiology doi: 10.1148/radiology.167.2.3282260 – volume: 50 start-page: 636 year: 2001 ident: 10.1016/j.ejrad.2025.112431_b0030 article-title: Surgeon-performed ultrasound in the critical care setting: its use as an extension of the physical examination to detect pleural effusion publication-title: J. Trauma doi: 10.1097/00005373-200104000-00007 – volume: 33 start-page: 1015 year: 2023 ident: 10.1016/j.ejrad.2025.112431_b0040 article-title: Did medical doctors who order abdominal CT scans during on-call hours truly become worse at clinical reasoning? yes, they did publication-title: Eur. Radiol. doi: 10.1007/s00330-022-09121-7 – volume: 90 start-page: 209 year: 2015 ident: 10.1016/j.ejrad.2025.112431_b0050 article-title: Performance in physical examination on the USMLE step 2 clinical skills examination publication-title: Acad. Med. doi: 10.1097/ACM.0000000000000570 – start-page: 263 year: 2016 ident: 10.1016/j.ejrad.2025.112431_b0005 article-title: History and physical – volume: 133 year: 2020 ident: 10.1016/j.ejrad.2025.112431_b0035 article-title: Point of care ultrasonography enhanced physical examination: a nephrologist's perspective publication-title: Am. J. Med. doi: 10.1016/j.amjmed.2020.01.015 – volume: 32 start-page: 442 year: 2020 ident: 10.1016/j.ejrad.2025.112431_b0015 article-title: The modern physical exam - a transatlantic perspective from the resident level publication-title: Teach. Learn. Med. doi: 10.1080/10401334.2020.1724792 – volume: 354 start-page: 548 year: 2006 ident: 10.1016/j.ejrad.2025.112431_b0010 article-title: demise of the physical exam publication-title: N. Engl. J. Med. doi: 10.1056/NEJMp068013 – volume: 24 start-page: 14 year: 2020 ident: 10.1016/j.ejrad.2025.112431_b0025 article-title: SICS Study Group. should the ultrasound probe replace your stethoscope? a SICS-I sub-study comparing lung ultrasound and pulmonary auscultation in the critically ill publication-title: Crit. Care doi: 10.1186/s13054-019-2719-8 |
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| SubjectTerms | Adult Aged Clinical Competence Clinical reasoning Female Humans Male Middle Aged Physical examination Physical Examination - statistics & numerical data Practice Patterns, Physicians' - statistics & numerical data Prospective Studies Referral and Consultation Referral and Consultation - statistics & numerical data Ultrasonography Ultrasonography - statistics & numerical data |
| Title | Physical examination before diagnostic ultrasonography: Alive and kicking or a relic of the past? |
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