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Related Experiment Videos

Percussion and physical diagnosis: separating myth from science

S R McGee1

  • 1Seattle Veterans Affairs Medical Center, Washington, USA.

Disease-A-Month : DM
|October 1, 1995
PubMed
Summary

Percussion sounds like tympany, resonance, and dullness are distinguishable. While comparative percussion for pleural effusions and shifting dullness for ascites are recommended, topographic and auscultatory percussion lack clinical utility and should be abandoned.

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Area of Science:

  • Medical Diagnostics
  • Physical Examination Techniques

Background:

  • Percussion is a fundamental bedside diagnostic technique.
  • Understanding percussion sounds (tympany, resonance, dullness) is crucial for physical examination.
  • Variability in percussion technique can influence sound production and interpretation.

Observation:

  • Clinicians show good agreement in identifying percussion sounds (dull, resonant, hyperresonant).
  • Interobserver agreement is poor when measuring organ spans using percussion.
  • Comparative percussion effectively detects large pleural effusions but is less sensitive for pneumonia.
  • Shifting dullness reliably detects ascites.

Findings:

  • Topographic percussion for organ borders is inaccurate and lacks clinical utility.

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  • Auscultatory percussion offers minimal advantage over conventional percussion and should be abandoned.
  • The principle underlying topographic percussion's limited tissue penetration is flawed.

    • Implications:

    • Clinical utility of percussion techniques varies significantly.
    • Comparative percussion and shifting dullness remain valuable diagnostic tools.
    • Topographic and auscultatory percussion should be discontinued as bedside diagnostic methods.