Diagnostic utility of the physical examination for pulmonary hypertension
Bibliographic record
Abstract
Background and Objective: Little is known about the utility of physical examination (PE) findings in patients with suspected pulmonary hypertension (PH) in the modern era. We aimed to determine the diagnostic utility of commonly referenced PE findings for PH when compared to the gold standard, right heart catheterization (RHC) Methods: Sequential patients undergoing RHC at the PH clinic in Calgary, Canada were prospectively enrolled and examined by a respirologist within 60 minutes of RHC. Examiners were blinded to indication and diagnosis. Examiners determined presence or absence of: high jugular venous pressure (JVP)>3cm, palpable P2, parasternal heave, abdominal-jugular reflex (AJR), loud P2, P2 louder than A2 (P2>A2), right-sided S3, and extra-physiologic splitting of S2. PE findings were compared to RHC to determine the sensitivity (Sn), specificity (Sp), positive (+LR) and negative likelihood ratio (-LR) values for identifying PH (mPAP≥25mmHg). Results: 105 patients were enrolled. 66% were female with a median age of 61 (Interquartile Range 28-85). 13 patients (12%) did not have PH (mPAP <25 mmHg). The diagnostic performances of PE findings are displayed in Table 1. Conclusions: The physical examination has inadequate diagnostic utility in detecting or excluding the presence of PH.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".