Performance of Point-of-Care Ultrasound Versus Traditional Physical Examination for the Bedside Evaluation of...

Splenomegaly is an important clinical sign associated with diverse pathologies. Traditional bedside physical examination maneuvers used to detect splenomegaly demonstrate poor diagnostic performance. Point-of-care ultrasound (POCUS) is a potential alternative. We sought to compare the diagnostic performance of structured physical examination maneuvers and POCUS in the bedside detection of splenomegaly. Internal medicine and hematology inpatients at Kingston Health Sciences Centre from February 2023 to June 2024 were prospectively enrolled. Participants underwent a structured physical exam comprised of Castell's Method, Traube's Method, Nixon's Method, and one-handed palpation followed by a POCUS examination. Radiographic confirmation of splenomegaly (spleen length >12 cm) was obtained via abdominal ultrasound, computed tomography, or magnetic resonance imaging within 1 month of enrollment. The performance of each diagnostic test was determined. Of 130 patients enrolled, 55 (38.5%) had radiographically confirmed splenomegaly. POCUS demonstrated higher diagnostic performance (sensitivity 70.9%, specificity 72.0%, Matthew's correlation coefficient 0.43) compared with physical exam maneuvers. The most specific physical exam maneuver was Nixon's method (90.8%), while percussion of Traube's space had the highest sensitivity (52.7%). POCUS measurements strongly correlated with formal imaging (Spearman rho=0.630; P<0.001). The diagnostic accuracy of POCUS was reduced in patients with elevated body mass index (P=0.027) and in those scanned within 2 hours of eating (P=0.047). The POCUS examination took almost twice as long as the combined physical exam maneuvers (median 142 vs. 82). POCUS outperforms traditional physical examination in detecting splenomegaly and correlates well with formal imaging, supporting its integration into bedside practice and medical education.