Selective screening for XXXX with physical examination and ultrasound.

@entity1 @entity101 @entity439 @entity453 @entity204 @entity1028
@entity1028 ( @entity1028 ) is an important cause of preventable @entity204 in older @entity1 . Persistently high rupture mortality rates indicate that these deaths can be prevented only by early detection and treatment of @entity1028 . In an effort to develop an effective and efficient program of @entity1028 detection, we selectively screened a high-risk population. @entity1 aged 60 to 75 years with @entity101 and/or @entity453 were randomly selected from a general medicine clinic and screened with physical examination and ultrasound. Eighteen previously unsuspected @entity439 , 3.6 to 5.9 cm in size (mean, 4.4 cm), were detected in 201 @entity1 , for a prevalence of 9% (95% confidence interval: 4.7% to 13.3%). The specificity and positive predictive value of ultrasound were each 100%. Abdominal palpation detected only half of these @entity439 , but missed none in @entity1 with an abdominal girth less than 100 cm (n = 6). This degree of sensitivity did not occur with "routine" examinations and requires that the examination be directed specifically toward @entity1028 detection. We conclude that undiagnosed AAAs are common in this large subgroup of the clinic population, that ultrasound is an excellent screening test for AAAs, and that physical examination may be adequate for screening thin @entity1 . We recommend that every two or three years @entity1 over the age of 50 years undergo careful abdominal palpation aimed at detecting AAAs, as part of the periodic health examination. We further recommend that obese older @entity1 at high risk for @entity1028 have at least one-time screening with abdominal ultrasound, regardless of findings on physical examination.
