What is the statistical significance of the following endocarditis physical assessment findings: Fever, Roth spots (retinal hemorrhages with pale centers), Osler nodes (painful lesions on the tips of fingers and toes), Murmur (cardiac), Janeway lesions (painless lesions on palms and soles), Anemia, Nail hemorrhage (splinter hemorrhages), and Emboli?

From the Guidelines

The presence of Fever, Roth spots, Osler nodes, Murmur, Janeway lesions, Anemia, Nail hemorrhage, and Emboli are all significant findings in endocarditis, with varying degrees of sensitivity and specificity, and their diagnosis and management should be guided by the most recent guidelines and evidence-based practice. When evaluating the statistical significance of these physical assessment findings, it is essential to consider the context of the patient's overall clinical presentation and risk factors.

• Fever is a common finding, present in many cases of endocarditis, but its sensitivity and specificity can vary greatly 1.
• The classic peripheral stigmata, such as Roth spots, Osler nodes, and Janeway lesions, are less common, occurring in a smaller percentage of patients, but their presence can substantially increase the likelihood of endocarditis, particularly in patients with predisposing cardiac conditions or risk factors 1.
• Murmur is a significant finding, present in approximately 85% of cases, and its presence should prompt consideration of endocarditis in at-risk patients 1.
• Anemia is present in about 70-90% of cases due to chronic inflammation, and its presence can be an important indicator of the disease 1.
• Embolic phenomena occur in 20-50% of patients and significantly impact prognosis, making their diagnosis and management critical in the treatment of endocarditis 1. The diagnosis of infective endocarditis is often imprecise, and a definitive diagnosis may be made with positive blood cultures and/or characteristic echocardiographic findings, as stated in the guidelines 1. The Duke criteria incorporate these findings into a validated diagnostic framework that guides clinical decision-making for suspected endocarditis, and their use is recommended in clinical practice. In clinical practice, the presence of these findings should be evaluated in the context of the patient's overall clinical presentation, and their diagnosis and management should be guided by the most recent guidelines and evidence-based practice, with a focus on reducing morbidity, mortality, and improving quality of life 1.

From the Research

Statistical Significance of Endocarditis Physical Assessment Findings

The following physical assessment findings are associated with endocarditis:

• F: Fever - no specific statistical significance mentioned in the provided studies
• R: Roth spots (retinal hemorrhages with pale centres) - a case study reported a patient with Roth spots in both eyes, diagnosed with subacute bacterial endocarditis 2
• O: Osler nodes (tips of fingers and toes, painful) - reported as one of the classic peripheral signs of infective endocarditis, along with Janeway lesions, splinter hemorrhages, and Roth spots 2, 3
• M: Murmur (cardiac) - a patient with a heart murmur was referred for further evaluation and diagnosed with subacute bacterial endocarditis 2
• J: Janeway lesions (palms and soles, painless) - reported as one of the classic peripheral signs of infective endocarditis, along with Osler nodes, splinter hemorrhages, and Roth spots 2, 3
• A: Anemia - no specific statistical significance mentioned in the provided studies
• N: Nail hemorrhage (i.e., splinter hemorrhages) - reported as one of the classic peripheral signs of infective endocarditis, along with Osler nodes, Janeway lesions, and Roth spots 2, 3
• E: Emboli - no specific statistical significance mentioned in the provided studies

Limitations of the Studies

The provided studies do not offer statistical significance for the mentioned physical assessment findings, but rather report on case studies and the association of certain signs with infective endocarditis 2, 3