Clinical examination for diagnosing circulatory shock
Bart Hiemstra1, Ruben J Eck, Frederik Keus
1Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Current Opinion in Critical Care
|June 2, 2017
Summary
Clinical examination alone is unreliable for estimating cardiac output (CO) in circulatory shock. Structured assessments combining multiple clinical signs significantly improve accuracy, offering a more reliable diagnostic approach.
Area of Science:
- Critical Care Medicine
- Cardiovascular Physiology
- Diagnostic Accuracy Studies
Background:
- Physicians rely on clinical examination and basic labs for circulatory shock diagnosis.
- Limited research exists on the diagnostic accuracy of clinical examination in shock.
- Circulatory shock is characterized by inadequate cardiac output (CO).
Purpose of the Study:
- To review the diagnostic accuracy of clinical examination in estimating CO in circulatory shock.
- To evaluate the effectiveness of single versus combined clinical signs for CO assessment.
Main Methods:
- Systematic review of recent studies on clinical examination for CO estimation.
- Analysis of univariable correlations between clinical signs and CO.
- Evaluation of diagnostic accuracy for both single signs and predefined clinical profiles.
Main Results:
- Single clinical signs (mottling, capillary refill time, temperature gradients) show poor correlation with CO.
- Physician's "educated guess" of CO based on unstructured examination has ~50% accuracy.
- Structured clinical profiles combining multiple signs achieve high accuracy (81-100%) for CO estimation.
Conclusions:
- Individual clinical signs are insufficient for estimating CO in shock.
- Unstructured clinical examination is unreliable for assessing CO.
- Structured clinical examination using combined signs offers superior accuracy and should be prioritized in clinical practice and future research.
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