Rev Assoc Med Bras
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Clinical Trial
[Diagnostic limitations of the physical examination in the identification of children with anemia].
A total of 143 children was randomly selected from a Pediatric out-patients clinic in order to evaluate the accuracy and reproductibility of the clinical signs of anemia. The patients, who ranged from 6 to 68 months old, were assessed on the basis of 2 clinical examinations performed independently by 2 physicians. Clinical diagnosis of anemia relied upon the examination for the presence of pallor through an inspection of the skin, conjunctivaes, lips, tongue and palms. ⋯ Almost all the children with hemoglobin concentration lower than 9.0 g/dL presented at least one suggestive clinical sign of anemia. The Kappa coefficient (K) demonstrated a mild agreement between the 2 examinations for the assessment of cutaneous pallor (K = +0.32) and moderate agreement for the evaluation of the conjunctivaes, lips-tongue and palms (K from +0.55 to +0.59). In view of limitation of the accuracy and reproductibility of the clinical signs of anemia, we may state that the determination of hemoglobin concentration should be introduced as a routine procedure of major importance in health care services.