Chest
Clinical InvestigationsMISCELLANEOUSParadoxical Movement of the Lateral Rib Margin (Hoover Sign) for Detecting Obstructive Airway Disease
Section snippets
Materials and Methods
The study was performed in an outpatient pulmonary clinic from February to June 2001. Every month one first-year resident in family medicine attended the clinic with an experienced pulmonologist. During the first week of each month, the residents were trained in the physical examination, and the study was performed during the remaining weeks. The presence or absence of the following signs were considered: wheezes, rhonchi, reduced breath sounds, and Hoover sign (when an evident paradoxical
Results
A total of 172 patients were included, 117 men (68%) and 55 women (32%) with a mean (SD) age of 66 years (10 years; range, 41 to 88 years). Sixty-four patients (37%) met the criteria for OAD (ie, FEV1/FVC ratio, < 0.70). The agreement between observers is detailed in Table 1. Values of κ higher than 0.6 (ie, substantial agreement) were only obtained in wheezes, Hoover sign, and clinical impression.
Values for sensitivity and specificity, positive prediction, negative prediction, LR+, and LR− are
Discussion
Hoover sign (ie, the paradoxical movement of the lateral rib margin) is a frequently forgotten finding in physical examinations and has not previously been carefully analyzed for detecting OAD. This study shows data of precision (agreement), data of diagnostic value from physicians of different level of experience, and comparisons with other widely studied signs. In this study, Hoover sign has been found to be useful for diagnosing OAD, with better results than those of other classic signs and
ACKNOWLEDGMENT
The author wishes to thank the nurse Sonsoles Diaz, and the residents I. Alcaraz, A. Bernabe, F. Mas, C. Diego, and M.R. Martinez-Guillamon for their enthusiastic participation.
References (22)
- et al.
Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone?
Am J Med
(1993) - et al.
The clinical evaluation for diagnosing obstructive airways disease in high-risk patients
Chest
(1994) - et al.
Why we need large, simple studies of the clinical examination: the problem and a proposed solution; the CARE-COAD1 Group
Lancet
(1999) - et al.
Respiratory muscle function and drive in chronic obstructive pulmonary disease
Clin Chest Med
(2000) - et al.
Abnormalities of chest wall motion in patients with chronic airflow obstruction
Thorax
(1984) The diagnostic significance of inspiratory movements of the costal margins
Am J Med Sci
(1920)- et al.
Mechanisms of paradoxical rib motion in patients with chronic obstructive pulmonary disease
Am Rev Respir Dis
(1986) Physical signs of diffuse airways obstruction and lung distension
Thorax
(1969)- et al.
Diagnosis of obstructive airways disease from the clinical examination
J Gen Intern Med
(1993) - et al.
Do the medical history and physical examination predict low lung function?
Arch Intern Med
(1993)