2015, Number 1-2
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ABSTRACTIntroduction: Evidence-based medicine combines the best scientific evidence available and clinical judgment in order to make medical decisions. The return to the ritual of the physical examination and its upgrading to evidence-based medicine are important in this age of technological medicine. Methods: A comparative meta-analysis was performed using eight databases, searching for articles in the past 50 years. A total of 90 articles were selected, which were then tested for homogeneity of data by using the odds ratio Breslow-Day statistic test. The studies found were combined and positive and negative predictive values were calculated using the Cochran-Mantel-Haenszel test. Results: The three main causes of acute abdominal pain in the emergency department (n = 12,706), were determined as appendicitis, cholecystitis and intestinal occlusion, including the primary signs found in acute abdomen with a chronic digestive disease. Appendicitis (n = 9,478): right lower quadrant pain with a positive predictive value (PPV) of 7.9 (7.3-8.5), and Von Blumberg sign, McBurney’s point with a PPV of 4.2 (1.1-6.3). Cholecystitis (n = 5,716): positive Murphy sign with a PPV of 2.8 (0.8-8.6), and abdominal rigidity with a PPV of 1.6 (1.0-2.5). Intestinal occlusion (n = 2,275): visible peristalsis with a PPV of 9.5 (16.3-22.4), and abdominal distension with a PPV of 6.3 (9.3-12.3). Abdominal exploration in chronic liver diseases (n= 3,134): wave sign for finding free ascites with a PPV of 6 (3.3-11.0), palpation with the patient supine in the search of a splenomegaly with a PPV of 8.2 (5.8-12), and search for palpable hepatomegaly in the liver edge with a PPV of 2 (1.5-2.8). Conclusion: Physical examination has always been essential to reach an appropriate diagnosis since the beginning of semiotics. The three main pathologies detected in this study can have their presumptive diagnosis through an appropriate examination of the patient, demonstrating that evidence-based medicine and the ritual of the physical examination are the best diagnostic examination method.
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