Clinical examination for diagnosing circulatory shock

Research output: Contribution to journalReview articlepeer-review

30 Citations (Scopus)
329 Downloads (Pure)

Abstract

Purpose of review: In the acute setting of circulatory shock, physicians largely depend on clinical examination and basic laboratory values. The daily use of clinical examination for diagnostic purposes contrasts sharp with the limited number of studies. We aim to provide an overview of the diagnostic accuracy of clinical examination in estimating circulatory shock reflected by an inadequate cardiac output (CO).

Recent findings: Recent studies showed poor correlations between CO and mottling, capillary refill time or central-to-peripheral temperature gradients in univariable analyses. The accuracy of physicians to perform an educated guess of CO based on clinical examination lies around 50% and the accuracy for recognizing a low CO is similar. Studies that used predefined clinical profiles composed of several clinical examination signs show more reliable estimations of CO with accuracies ranging from 81 up to 100%.

Summary: Single variables obtained by clinical examination should not be used when estimating CO. Physician's educated guesses of CO based on unstructured clinical examination are like the flip of a coin'. Structured clinical examination based on combined clinical signs shows the best accuracy. Future studies should focus on using a combination of signs in an unselected population, eventually to educate physicians in estimating CO by using predefined clinical profiles.

Original languageEnglish
Pages (from-to)293-301
Number of pages9
JournalCurrent opinion in critical care
Volume23
Issue number4
DOIs
Publication statusPublished - 1-Aug-2017

Keywords

  • cardiac output
  • circulatory shock
  • clinical examination
  • critical illness
  • diagnostic accuracy
  • physical examination
  • shock
  • CRITICALLY-ILL PATIENTS
  • PULMONARY-ARTERY CATHETERIZATION
  • PERIPHERAL TEMPERATURE-GRADIENT
  • ACUTE MYOCARDIAL-INFARCTION
  • INTENSIVE-CARE-UNIT
  • CARDIAC-OUTPUT
  • HEMODYNAMIC ASSESSMENT
  • SEPTIC SHOCK
  • HEART-RATE
  • MICROCIRCULATORY ALTERATIONS

Cite this