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Do you DxTest?

    • 1 posts
    May 19, 2014 1:43:34 PM PDT

    Doc's, do you currently refer your patients out to hospitals or specialists for vascular testing or nerve studies?


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    This post was edited by DxTestingWHP at May 19, 2014 1:47:50 PM PDT
    • 445 posts
    May 20, 2014 8:05:42 AM PDT


    Thanks for your post. We have reviewed your website and you do provide an excellent service to the health community.

    Your post is a valuable contribute to DrSocial community.

    • 1955 posts
    May 20, 2014 11:06:32 PM PDT

    Bruits in the upper and midcervical region usually signified ipsilateral carotid artery stenosis. However. there was also silent contralateral stenosis in 28% of the cases. Be a thinking doctor.

    In patients who are not dizzy, also known as "asymptomatic," DO #ChooseWisely and Auscultate the carotids

    1. listen to the carotids, => hear a murmur => order doppler ultrasound of the carotids => 

                                                                      help save a life.

    Auscultate the carotids at least initial visit. Yearly exam check carotids c stethoscope, it is free. If you hear a bruit, even in an asypmtomatic adult over 40, strongly consider referral for duplex on initial diagnosis.


    Choosing Wisely, ABIM, Carotid Stenosis Screening

    This post was edited by DrSocial Admin at August 14, 2014 8:47:13 AM PDT
    • 1955 posts
    May 20, 2014 11:14:52 PM PDT

    Although the choosing wisely movement suggested that carotid auscultation is unreliable, I thought it's best to check the medical literature because such advice, even from a leading medical organization may not always be correct.

    The error in choosing wisely arose because they apparently did not check the original paper and assumed a summary claiming that the there is "low" reliability between auscultation of a bruit, and the presence of significant stenosis (as defined in the paper).

    Key point: Check the original references before making national recommendations instructing physicians on what nefarious diseases they should not screen for. 

    This post was edited by DrSocial Admin at October 5, 2014 11:16:56 AM PDT
    • 1955 posts
    May 20, 2014 11:24:34 PM PDT

    NPs Save Lives in MO

    This post was edited by Brett Snodgrass at May 20, 2014 11:25:46 PM PDT
    • 1955 posts
    August 14, 2014 6:23:43 AM PDT

    These are the references for the Choosing wisely campaign and form the basis for the 2014 USPSTF recommendation. However, they are probably not actually grade-D as the USPSTF claims, as that means they recommend against it. 

    This post was edited by DrSocial Admin at April 26, 2015 4:13:41 PM PDT
    • 1955 posts
    September 13, 2014 4:26:19 PM PDT

    Accuracy of Screening Tests

    Two meta-analyses provide information on the accuracy of carotid duplex ultrasonography in detecting clinically important stenosis. Recent systematic reviews of studies about the accuracy of carotid duplex ultrasonography, by using digital subtraction angiography as the reference standard, estimated the sensitivity to be 86% to 90% and the specificity to be 87% to 94% for detecting CAS greater than 70%.3,4 The estimated sensitivity and specificity of carotid duplex ultrasonography to detect CAS of 60% or more are approximately 94% and 92%, respectively.3 The reliability of carotid duplex ultrasonography is not established.3 One meta-analysis noted that the measurement properties used among various ultrasonography laboratories varied greatly and to a clinically important degree.3 

    In 1996, the USPSTF reviewed the evidence for screening for bruits on physical examination and found that the test had poor reliability and poor sensitivity.5

    Reference 5 

    5. Guide to Clinical Preventive Services, 2nd Edition: U.S. Preventive Services Task Force; 1996.

     Reference 5 cites the above 1985 article ! and there are numerous limitations in the interpretation made, including the opposite conclusion. The auscultation is not merely a yes no test, it was also a quantified test. Thus, conclusion made in 1996 was not granular, had multiple limitations, and may be the exact opposite of what the present-day USPSTF concludes about reliability, and sensitivity. Sensitivity for what matters, in addition, is the test reliable at the loud bruit range? Do you know that the people had a hearing test before teh study was conducted? There were only two observers in the study. the presence or absence of a loud bruit would likely be VERY RELIABLE. Nonetheless, the USPSTF did not permit commentary on the article and assumed that the 1996 review warrants  the discontinuation of potentially life-saving screening test. In my humble opinion, the recommendation should probably be a Grade C and not a Grade D. 

    This post was edited by DrSocial Admin at September 14, 2014 5:57:39 AM PDT