The Accuracy of Physical Examination to Detect Abdominal Aortic Aneurysm

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Abstract
ABDOMINAL AORTIC aneurysms (AAAs) cause more than 10 000 deaths each year in the United States,1 and many of these deaths should be preventable by early detection and elective repair of the aneurysm.2 Abdominal palpation during physical examination is an important means of AAA detection, accounting for about one third of new diagnoses.3 Palpation for AAA is one of the few physical examination maneuvers recommended for the periodic health examination of older men,4 and may be more cost-effective for screening than ultrasound.5 The literature on the accuracy of abdominal palpation for AAA has recently been reviewed,6 but important questions remain. Of the 15 studies of abdominal palpation for AAA in which the diagnosis was not known in advance by the examiner, only 1 included more than 10 patients with AAAs 4.0 cm in diameter or larger.6 Furthermore, the effect of patient factors, such as abdominal obesity or tightness, on the accuracy of AAA palpation has received little attention. We are also aware of no studies reporting interobserver agreement on palpation findings; nor are we aware of any data addressing whether negative findings are more reliable for excluding AAA when the aorta is palpable than when it is not. The purpose of the present study is to provide more detailed information on the accuracy of abdominal palpation for AAA.