Evaluation of cardiovascular propedeutics impact in clinical diagnostic reasoning of patients with suspected valvulopathies

• Grant number: 22/03747-9
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: May 01, 2022
• End date: April 30, 2023
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Minna Moreira Dias Romano
• Grantee: Isabella Silveira Teixeira
• Host Institution: Faculdade de Medicina de Ribeirão Preto (FMRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil

Abstract

In medical semiology context, the diagnostic hypothesis elaboration exercise and clinical diagnostic reasoning (CDR) establishment can be divided into 3 pillars: Anamnesis, physical examination (PE) and complementary exams. The technological evolution of complementary diagnostic methods has changed the way health professionals construct the CDR. Throughout time, less semiological propedeutics valuing and more subsidiary exams dependency is observed in therapeutic conduct determination. Some studies have already demonstrated the accuracy of diagnostic anamnesis, which can predict the clinical diagnosis of even 80% of internal medicine cases in ambulatorial scenery. However, few studies have quantified the role of PE. In valvar cardiac diseases sceneries, the cardiovascular PE can be the great responsible for nosologic diagnosis and suggest, yet, the severity, guiding with cost-effectivity the use of image complementary methods. It can, also, have an important role in therapeutic decision making. OBJECTIVES: The present study has as its main objective to evaluate the impact of cardiovascular PE realization in CDR. Still, it seeks to (1) compare the PE abilities between volunteers with different formation degrees; (2) compare, among the avaliated groups that could or not make the cardiovascular PE, the number of complementary exams solicited for the nosologic diagnosis; (3) compare the agreeing or disagreeing echocardiography exam result interpretation by the groups which did or didn't make de PE. Methods: volunteers, graduation students and cardiology resident physicians, will be invited to participate in the project. Each volunteer will receive simulator training, and will be exposed to four predefined clinical situations, simulating valvulopathies sceneries ( mitral insufficiency and stenosis, aortic insufficiency and stenosis) composed by clinical vignette (anamnesis) associated with simulated PE findings in high fidelity simulator (Harvey®; Gordon Center for Research in Medical Education, University of Miami, Miami, FL, USA). The volunteers will be randomly assigned to times when they can or cannot execute the PE on the simulator (intervention variable) for each of the valvular pathologies. In subsequent steps, the volunteer will be exposed to echocardiography reports that may be in agreement or in disagreement with the simulated case. Tests about the likely clinical diagnosis and the complementary exams solicitation conduct will be then introduced to the volunteers. The performance in identifying PE findings will be measured, as well as the answers to questions about diagnostic or therapeutic approaches. Continuous variables, such as mean and SD, and categorical variables such as percentage and frequency will be expressed. The groups will be compared with appropriate tests for the distribution of variables, considering the possibility of performing the PE or not, the volunteers time formation and the presented valvulopathy. Sensibility and Specificity analyses of PE variables in diagnosing each of the valvulopathies will be performed. Finally, analyses of echocardiogram reports interpretation impact (in agreement or not with the presented scenario) will be quantified and compared between groups which performed the PE or did not.(AU)