Clinical Diagnosis of Congestive Heart Failure in Patients with Acute Dyspnea: Methods (Part 3)

Clinical Diagnosis of Congestive Heart Failure in Patients with Acute Dyspnea: Methods (Part 3)The diagnosis of congestive heart failure was then made by the application of a clinicoradiographic score (Table 1) which has been previously validated,10 “ which was modified for use in this study by removing “wheezing” from the physical examination criteria. This modification was made to reflect the nature of the population l)eing studied, where a high prevalence of patients with asthma or chronic lung disease might be expected to lead to an overdiagnosis of congestive heart failure if this criterion were retained. For this study, the diagnosis of congestive heart failure required a score of 8 or more, classified as “definite” congestive heart failure by the authors of these criteria.
The response to physical examination maneuvers was compared with the diagnosis of congestive heart failure. Sensitivity, specificity, and predictive value of these clinical maneuvers were defined in a standard manner,’- and were assessed against the diagnosis by both the emergency room physician and by the criteria. Statistical significance of associations was determined using the one-tailed Fishers exact test. The relation between diagnosis by criteria and by the physician was assessed by the kappa statistic, which corrects observed agreement for that expected by chance alone.” buy antibiotics online

 Table 1—Boston Criteria for Congestive Heart Failure 




Category I: History

Rest dyspnea




Paroxysmal nocturnal dyspnea


Dyspnea on walking on level


Dyspnea on climbing


Category II: Physical examination

Heart rate abnormality

(if 91-110 beats/min, 1 point; if >110 l>eats/min, 2 points)


Jugular-venous pressure elevation

(if >6 cm H20, 2 points; if >6 cm ILO plus hepatomegaly or edema, 3 points)


Lung crackles

(if basilar, 1 point, if more than basilar, 2 points)




Third heart sound


Category III: Chest radiograph)

Alveolar pulmonary edema


Interstitial pulmonary edema


Bilateral pleural effusions


Cardiothoracic ratio >0.50 (posteroanterior projection)


Upper zone flow redistribution


*No more than 4 points were allowed from each of each of three categories, and hence the composite score, the sum of the subtotal from each category, had a maximum |)ossible of 12 points. The diagnosis of heart failure was classified as definite for a score of 8 to 12 points, possible for a score of 5 to 7 points, and unlikely for a score of 4 points or less.

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