Articles
The accuracy of clinical assessment of bladder volume,☆☆,,★★

https://doi.org/10.1053/apmr.2002.34287Get rights and content

Abstract

Weatherall M, Harwood M. The accuracy of clinical assessment of bladder volume. Arch Phys Med Rehabil 2002;83:1300-2. Objective: To determine the usefulness of physical examination in detecting elevated bladder volume. Design: A blinded study of clinical examination by physicians to detect elevated bladder volumes compared with a criterion standard (ultrasonic bladder volume measurement). Setting: Outpatient department of a general hospital in New Zealand. Participants: Sixteen healthy adult volunteers (age range, 21–37y; body mass index range, 22.9–37.2kg/m2) and 8 qualified resident physicians with 2 to 6 years of clinical experience. Intervention: Elevated bladder volumes were achieved by randomly allocating the volunteers to void or not to void before the clinical examination. Main Outcome Measure: Clinical examination of the abdomen by abdominal palpation and suprapubic percussion, compared with portable ultrasound findings, to determine whether a healthy adult has a full bladder. Results: For bladder volumes of 400 to 600mL, physical examination to detect a full bladder was 81% sensitive (95% confidence interval [CI], 54–96), 50% specific (95% CI, 39–68), and 55% accurate (95% CI, 45–65). The likelihood ratio for a positive finding on physical examination was 1.62 (95% CI, 1.17–2.24). Conclusion: Physical examination of the abdomen by relatively junior physicians is unreliable in detecting bladder volumes between 400 and 600mL in healthy volunteers. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Methods

The study design was a controlled comparison of the ability of a group of physicians to determine whether a person had a full bladder. Approval was obtained from the Regional Ethics Committee before the study.

Eight registered physicians with between 2 to 6 years of clinical experience examined 16 volunteers and performed a total of 96 clinical examinations to detect elevated bladder volume. Physicians were not instructed before the examinations. Recruited from the local hospital, they

Results

The range of residual bladder volumes for volunteers who voided was 0 to 51mL. For volunteers who did not void, the bladder volumes ranged between 254 and 925mL.

When the diagnosis of a full bladder was arbitrarily set at 200mL, a full bladder was correctly diagnosed in 26 examinations, and an empty bladder was correctly diagnosed in 39 examinations (table 1).However, a full-bladder diagnosis was made in 10 examinations when there were less than 200mL, and 21 examinations incorrectly assessed

Discussion

Despite recommendations to clinically assess PVR bladder volume in the current guidelines for management of urinary incontinence,7 its usefulness as a diagnostic test has never been examined. To prevent bladder distension and injury, clinicians must correctly identify bladder volumes that exceed 500mL. Our results suggest that when the bladder volume is 400 to 600mL, clinical examination is inaccurate. We have expressed the accuracy and clinical usefulness of abdominal examination to detect

Conclusion

Clinical examination is unreliable in the assessment of elevated bladder volumes, and there are significant implications for assessment of people with continence problems. This is particularly true for settings in which the prevalence of elevated bladder volumes after voiding is high, such as in rehabilitation units. Poor management of urinary incontinence in acute rehabilitation may lead to a significant loss of therapy time and an increase in the nursing workload.4 A more refined diagnostic

Cited by (0)

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

☆☆

Reprint requests to Mark Weatherall, FRACP, Dept of Medicine, University of Otago, Wellington School of Medicine, PO Box 7343, Wellington South, New Zealand, e-mail: [email protected].

Supplier

★★

a. BladderScan BVI 3000; Diagnostic Ultrasound Corp, 18109 NE 76th St, Redmond, WA 98052.

View full text