Signs and Evidence

Making clinical sense of scientific data

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Abdominal Mass
 Small bowel obstruction
 Positive likelihood ratio
2.2 ( Bohner H et al. )
(average) 2.2
Negative likelihood ratio
0.9 ( Bohner H et al. )
(average) 0.9
 Aneurysma aorta abdominalis
 Positive likelihood ratio
12 ( Lederle FA et al. )
(average) 12
Negative likelihood ratio
0.72 ( Lederle FA et al. )
(average) 0.72
Abdominal pain
 Influenza during flu season
 Positive likelihood ratio
1.42 ( Ebell MH et al. )
(average) 1.42
Negative likelihood ratio
0.94 ( Ebell MH et al. )
(average) 0.94
 Urinary tract infection in women
 Positive likelihood ratio
1.00 ( Giesen LGM et al. )
1.1 ( Bent S et al. )
(average) 1.05
Negative likelihood ratio
1.00 ( Giesen LGM et al. )
0.9 ( Bent S et al. )
(average) 0.95
 Small bowel obstruction
 Positive likelihood ratio
2.9 ( Bohner H et al. )
(average) 2.9
Negative likelihood ratio
0.8 ( Bohner H et al. )
(average) 0.8
 Diverticulitis
 Positive likelihood ratio
3.3 ( Wilkins T et al. )
(average) 3.3
Negative likelihood ratio
0.5 ( Wilkins T et al. )
(average) 0.5
Absence of cough
 Streptococcal pharyngitis
 Positive likelihood ratio
1.46 ( Aalbers J et al. )
(average) 1.46
Negative likelihood ratio
0.53 ( Aalbers J et al. )
(average) 0.53
Active extension causing pain
 Hip arthrosis
 Positive likelihood ratio
2.7 ( Sutlive TG et al. )
(average) 2.7
Negative likelihood ratio
0.59 ( Sutlive TG et al. )
(average) 0.59
Angina
 Heart failure
 Positive likelihood ratio
3.00 ( Morgan S et al. )
(average) 3
Negative likelihood ratio
0.62 ( Morgan S et al. )
(average) 0.62
Ankle reflex abnormal
 Disc herniation
 Positive likelihood ratio
4.3 ( David S at al. )
(average) 4.3
Negative likelihood ratio
0.6 ( David S at al. )
(average) 0.6
Anorexia
 Cholecystitis
 Positive likelihood ratio
1.4 ( Trowbridge RL et al. )
(average) 1.4
Negative likelihood ratio
0.7 ( Trowbridge RL et al. )
(average) 0.7
 Appendicitis
 Positive likelihood ratio
3.17 ( Idris SA et al. )
1.05 ( Al-gaithy Zuhoor K et )
(average) 2.11
Negative likelihood ratio
0.07 ( Idris SA et al. )
0.53 ( Al-gaithy Zuhoor K et )
(average) 0.3
 Temporal Arteritis
 Positive likelihood ratio
0.95 ( Ryan D et al. )
(average) 0.95
Negative likelihood ratio
1.03 ( Ryan D et al. )
(average) 1.03
 Otitis media acuta
 Positive likelihood ratio
1.06 ( Wood JM et al. )
(average) 1.06
Negative likelihood ratio
0.97 ( Wood JM et al. )
(average) 0.97
Anterior drawer test
 Anterior cruciate ligament tear - acute
 Positive likelihood ratio
7.33 ( Katz JW et al. )
1.4 ( Benjaminse A et al. )
(average) 4.37
Negative likelihood ratio
0.80 ( Katz JW et al. )
0.7 ( Benjaminse A et al. )
(average) 0.75
 Anterior cruciate ligament tear - chronic
 Positive likelihood ratio
17.67 ( Katz JW et al. )
8.9 ( Benjaminse A et al. )
(average) 13.29
Negative likelihood ratio
0.48 ( Katz JW et al. )
0.1 ( Benjaminse A et al. )
(average) 0.29
Aphasia - ever
 Stroke
 Positive likelihood ratio
7.60 ( Sung VW et al. )
(average) 7.6
Negative likelihood ratio
0.65 ( Sung VW et al. )
(average) 0.65
Apley's test
 Meniscal tear - acute
 Positive likelihood ratio
2.9 ( Rinonapoli G et al. )
0.80 ( Fowler PJ et al. )
1.30 ( Kurosaka M et al. )
(average) 1.67
Negative likelihood ratio
0.2 ( Rinonapoli G et al. )
1.05 ( Fowler PJ et al. )
0.97 ( Kurosaka M et al. )
(average) 0.74
Asymmetry
 Melanoma
 Positive likelihood ratio
2.0 ( Mark Ebell et al. )
2.1 ( Thomas L et al. )
(average) 2.05
Negative likelihood ratio
0.60 ( Mark Ebell et al. )
0.59 ( Thomas L et al. )
(average) 0.6
Back pain
 Urinary tract infection in women
 Positive likelihood ratio
0.88 ( Giesen LGM et al. )
1.6 ( Bent S et al. )
(average) 1.24
Negative likelihood ratio
1.09 ( Giesen LGM et al. )
0.8 ( Bent S et al. )
(average) 0.95
Bedwetting
 Epilepsy
 Positive likelihood ratio
6.53 ( Sheldon R et al. )
(average) 6.53
Negative likelihood ratio
0.79 ( Sheldon R et al. )
(average) 0.79
Bilateral plantar numbness
 Spinal stenosis
 Positive likelihood ratio
2.1 ( Ebell MH et al. )
2.2 ( Suri P et al. )
(average) 2.15
Negative likelihood ratio
0.84 ( Ebell MH et al. )
0.84 ( Suri P et al. )
(average) 0.84
Bowel sound decreased
 Small bowel obstruction
 Positive likelihood ratio
3.2 ( Bohner H et al. )
(average) 3.2
Negative likelihood ratio
0.8 ( Bohner H et al. )
(average) 0.8
Bowel sounds increased
 Small bowel obstruction
 Positive likelihood ratio
3.5 ( Bohner H et al. )
(average) 3.5
Negative likelihood ratio
0.7 ( Bohner H et al. )
(average) 0.7
Breathing frequency > 40 / min
 Pneumonia in children
 Positive likelihood ratio
1.58 ( Rambaud-Althaus C et al. )
(average) 1.58
Negative likelihood ratio
0.43 ( Rambaud-Althaus C et al. )
(average) 0.43
Brudzinski's sign
 Meningitis
 Positive likelihood ratio
1.00 ( Thomas KE et al. )
3.42 ( Ala A et al. )
2.12 ( Mofidi M et al. )
(average) 2.18
Negative likelihood ratio
1.00 ( Thomas KE et al. )
0.30 ( Ala A et al. )
0.72 ( Mofidi M et al. )
(average) 0.67
Bulging tympanic membrane
 Otitis media acuta
 Positive likelihood ratio
20 ( R Rothman et al. )
(average) 20
Negative likelihood ratio
0.4 ( R Rothman et al. )
(average) 0.4
Buttock Pain
 Hip arthrosis
 Positive likelihood ratio
6.4 ( Sutlive TG et al. )
(average) 6.4
Negative likelihood ratio
0.52 ( Sutlive TG et al. )
(average) 0.52
Calf wasting
 Disc herniation
 Positive likelihood ratio
5.2 ( David S at al. )
(average) 5.2
Negative likelihood ratio
0.8 ( David S at al. )
(average) 0.8
Central obesity
 Cushing syndrome
 Positive likelihood ratio
3.12 ( Nugent CA et al. )
(average) 3.12
Negative likelihood ratio
0.14 ( Nugent CA et al. )
(average) 0.14
Cervical adenopathy
 Mononucleosis
 Positive likelihood ratio
2.1 ( Mark H et al. )
(average) 2.1
Negative likelihood ratio
0.22 ( Mark H et al. )
(average) 0.22
 Streptococcal pharyngitis
 Positive likelihood ratio
1.45 ( Aalbers J et al. )
(average) 1.45
Negative likelihood ratio
0.63 ( Aalbers J et al. )
(average) 0.63
Cheesy discharge
 Vaginal candidiasis
 Positive likelihood ratio
2.4 ( Anderson MR et al. )
(average) 2.4
Negative likelihood ratio
0.48 ( Anderson MR et al. )
(average) 0.48
Chest-wall tenderness
 Acute coronary syndrome
 Positive likelihood ratio
0.17 ( Rudi Bruyninckx et al. )
0.30 ( Goodacre S et al. )
0.23 ( Mant J et al. )
(average) 0.23
Negative likelihood ratio
1.41 ( Rudi Bruyninckx et al. )
1.27 ( Goodacre S et al. )
1.18 ( Mant J et al. )
(average) 1.29
 Pneumonia in children
 Positive likelihood ratio
1.9 ( Shah SN et al. )
(average) 1.9
Negative likelihood ratio
0.82 ( Shah SN et al. )
(average) 0.82
Chills
 Influenza during flu season
 Positive likelihood ratio
1.11 ( Ebell MH et al. )
(average) 1.11
Negative likelihood ratio
0.68 ( Ebell MH et al. )
(average) 0.68
 Cholecystitis
 Positive likelihood ratio
2.6 ( Abraham S et al. )
(average) 2.6
Negative likelihood ratio
0.9 ( Abraham S et al. )
(average) 0.9
 Pneumonia in adults
 Positive likelihood ratio
1.72 ( Heckerling PS et al. )
(average) 1.72
Negative likelihood ratio
0.70 ( Heckerling PS et al. )
(average) 0.7
Clock drawing test
 Dementia
 Positive likelihood ratio
4.00 ( Kirby M et al. )
(average) 4
Negative likelihood ratio
0.30 ( Kirby M et al. )
(average) 0.3
Closed fist sign
 Carpal tunnel syndrome
 Positive likelihood ratio
7.3 ( Christopher A et al. )
(average) 7.3
Negative likelihood ratio
0.4 ( Christopher A et al. )
(average) 0.4
Cloudy tympanic membrane
 Otitis media acuta
 Positive likelihood ratio
11 ( R Rothman et al. )
(average) 11
Negative likelihood ratio
0.1 ( R Rothman et al. )
(average) 0.1
Colic pain
 Cholelithiasis
 Positive likelihood ratio
3.6 ( Abraham S et al. )
(average) 3.6
Negative likelihood ratio
0.84 ( Abraham S et al. )
(average) 0.84
Constipation
 Hypothyroidism
 Positive likelihood ratio
2.29 ( Carle A et al. )
3.20 ( Zulewski H et al. )
(average) 2.75
Negative likelihood ratio
0.74 ( Carle A et al. )
0.61 ( Zulewski H et al. )
(average) 0.68
 Small bowel obstruction
 Positive likelihood ratio
8.8 ( Bohner H et al. )
(average) 8.8
Negative likelihood ratio
0.6 ( Bohner H et al. )
(average) 0.6
Cool skin
 Peripheral arterial disease
 Positive likelihood ratio
5.9 ( Khan NA et al. )
(average) 5.9
Negative likelihood ratio
0.92 ( Khan NA et al. )
(average) 0.92
 Hypothyroidism
 Positive likelihood ratio
2.50 ( Carle A et al. )
(average) 2.5
Negative likelihood ratio
0.63 ( Carle A et al. )
(average) 0.63
Cough
 Influenza during flu season
 Positive likelihood ratio
1.29 ( Ebell MH et al. )
(average) 1.29
Negative likelihood ratio
0.38 ( Ebell MH et al. )
(average) 0.38
 Upper respiratory infection
 Positive likelihood ratio
0.92 ( Nader Shaikh et al. )
(average) 0.92
Negative likelihood ratio
2.40 ( Nader Shaikh et al. )
(average) 2.4
 Acute sinusitis
 Positive likelihood ratio
0.96 ( Claude Cyr et al. )
(average) 0.96
Negative likelihood ratio
1.12 ( Claude Cyr et al. )
(average) 1.12
 Asthma in children
 Positive likelihood ratio
2.6 ( ITS Yu et al. )
(average) 2.6
Negative likelihood ratio
0.49 ( ITS Yu et al. )
(average) 0.49
 COPD
 Positive likelihood ratio
1.8 ( Dewar M et al. )
(average) 1.8
Negative likelihood ratio
0.69 ( Dewar M et al. )
(average) 0.69
 Hypothyroidism
 Positive likelihood ratio
1.46 ( Carle A et al. )
(average) 1.46
Negative likelihood ratio
0.91 ( Carle A et al. )
(average) 0.91
 Otitis media acuta
 Positive likelihood ratio
0.9 ( R Rothman et al. )
(average) 0.9
Negative likelihood ratio
1.2 ( R Rothman et al. )
(average) 1.2
 Pneumonia in children
 Positive likelihood ratio
1.12 ( Rambaud-Althaus C et al. )
1.2 ( Shah SN et al. )
0.99 ( Zanco J et al. )
(average) 1.1
Negative likelihood ratio
0.30 ( Rambaud-Althaus C et al. )
0.47 ( Shah SN et al. )
2.00 ( Zanco J et al. )
(average) 0.92
Crackles
 Pneumonia in children
 Positive likelihood ratio
1.26 ( Rambaud-Althaus C et al. )
1.4 ( Shah SN et al. )
1.02 ( Zanco J et al. )
(average) 1.23
Negative likelihood ratio
0.81 ( Rambaud-Althaus C et al. )
0.86 ( Shah SN et al. )
0.87 ( Zanco J et al. )
(average) 0.85
 Pneumonia in adults
 Positive likelihood ratio
2.6 ( Heckerling PS et al. )
2.0 ( Saldias PF et al. )
1.6 ( Gennis P et al. )
2.7 ( Diehr P et al. )
(average) 2.23
Negative likelihood ratio
0.6 ( Heckerling PS et al. )
0.6 ( Saldias PF et al. )
0.8 ( Gennis P et al. )
0.9 ( Diehr P et al. )
(average) 0.73
 Heart failure
 Positive likelihood ratio
2.8 ( Wang CS et al. )
2.44 ( Morgan S et al. )
(average) 2.62
Negative likelihood ratio
0.51 ( Wang CS et al. )
0.68 ( Morgan S et al. )
(average) 0.6
 Acute coronary syndrome
 Positive likelihood ratio
2.08 ( Mant J et al. )
(average) 2.08
Negative likelihood ratio
0.76 ( Mant J et al. )
(average) 0.76
Cut tongue
 Epilepsy
 Positive likelihood ratio
16.70 ( Sheldon R et al. )
(average) 16.7
Negative likelihood ratio
0.56 ( Sheldon R et al. )
(average) 0.56
Cyanosis
 Pneumonia in adults
 Positive likelihood ratio
5.0 ( Saldias PF et al. )
(average) 5
Negative likelihood ratio
0.9 ( Saldias PF et al. )
(average) 0.9
Decreased breath sounds on examination
 COPD
 Positive likelihood ratio
3.7 ( Dewar M et al. )
(average) 3.7
Negative likelihood ratio
0.7 ( Dewar M et al. )
(average) 0.7
 Pneumonia in adults
 Positive likelihood ratio
2.5 ( Heckerling PS et al. )
(average) 2.5
Negative likelihood ratio
0.6 ( Heckerling PS et al. )
(average) 0.6
Diameter > 6 mm
 Melanoma
 Positive likelihood ratio
2.4 ( Mark Ebell et al. )
2.3 ( Thomas L et al. )
(average) 2.35
Negative likelihood ratio
0.16 ( Mark Ebell et al. )
0.17 ( Thomas L et al. )
(average) 0.17
Diarrhea
 HIV infection
 Positive likelihood ratio
3.7 ( Wood E et al. )
(average) 3.7
Negative likelihood ratio
0.88 ( Wood E et al. )
(average) 0.88
 Appendicitis
 Positive likelihood ratio
0.71 ( Idris SA et al. )
(average) 0.71
Negative likelihood ratio
1.78 ( Idris SA et al. )
(average) 1.78
Diastolic murmur
 Aortic insufficiency
 Positive likelihood ratio
4.5 ( Choudhry NK et al. )
(average) 4.5
Negative likelihood ratio
0.8 ( Choudhry NK et al. )
(average) 0.8
Difference in calf diameter
 Deep venous thrombosis (DVT)
 Positive likelihood ratio
1.8 ( Goodacre S et al. )
(average) 1.8
Negative likelihood ratio
0.57 ( Goodacre S et al. )
(average) 0.57
Digital rectal exam abnormal
 Prostate cancer
 Positive likelihood ratio
21 ( Driel MF et al. )
3.12 ( Mistry K et al. )
(average) 12.06
Negative likelihood ratio
0.38 ( Driel MF et al. )
0.57 ( Mistry K et al. )
(average) 0.48
Diplopia
 Temporal Arteritis
 Positive likelihood ratio
1.99 ( Ryan D et al. )
(average) 1.99
Negative likelihood ratio
0.96 ( Ryan D et al. )
(average) 0.96
Discoloured skin
 Peripheral arterial disease
 Positive likelihood ratio
2.8 ( Khan NA et al. )
(average) 2.8
Negative likelihood ratio
0.74 ( Khan NA et al. )
(average) 0.74
Drop arm test
 Rotator cuff injury
 Positive likelihood ratio
1.42 ( Penning L et al. )
(average) 1.42
Negative likelihood ratio
0.94 ( Penning L et al. )
(average) 0.94
 Subacromial impingement syndrome
 Positive likelihood ratio
2.33 ( Çalış M et al. )
2.63 ( Alqunaee M et al. )
(average) 2.48
Negative likelihood ratio
0.96 ( Çalış M et al. )
0.86 ( Alqunaee M et al. )
(average) 0.91
Dullness on percussion
 Pneumonia in adults
 Positive likelihood ratio
4.0 ( Diehr P et al. )
3.5 ( Melbye H et al. )
3.7 ( Kern DG et al. )
2.2 ( Gennis P et al. )
(average) 3.35
Negative likelihood ratio
1.0 ( Diehr P et al. )
0.9 ( Melbye H et al. )
0.8 ( Kern DG et al. )
0.9 ( Gennis P et al. )
(average) 0.9
Dyspnea
 COPD
 Positive likelihood ratio
1.2 ( Dewar M et al. )
(average) 1.2
Negative likelihood ratio
0.55 ( Dewar M et al. )
(average) 0.55
Dysuria
 Urinary tract infection in women
 Positive likelihood ratio
4.71 ( Giesen LGM et al. )
1.5 ( Bent S et al. )
(average) 3.11
Negative likelihood ratio
0.24 ( Giesen LGM et al. )
0.5 ( Bent S et al. )
(average) 0.37
 Chlamydia
 Positive likelihood ratio
1.95 ( Berntsson M et al. )
(average) 1.95
Negative likelihood ratio
0.88 ( Berntsson M et al. )
(average) 0.88
Ear pain
 Otitis media acuta
 Positive likelihood ratio
4.4 ( R Rothman et al. )
3.00 ( Wood JM et al. )
(average) 3.7
Negative likelihood ratio
0.5 ( R Rothman et al. )
0.56 ( Wood JM et al. )
(average) 0.53
Edema lower extremities
 Heart failure
 Positive likelihood ratio
2.3 ( Wang CS et al. )
2.00 ( Morgan S et al. )
(average) 2.15
Negative likelihood ratio
0.64 ( Wang CS et al. )
0.90 ( Morgan S et al. )
(average) 0.77
 Cushing syndrome
 Positive likelihood ratio
2.27 ( Nugent CA et al. )
(average) 2.27
Negative likelihood ratio
0.74 ( Nugent CA et al. )
(average) 0.74
Egophony
 Pneumonia in adults
 Positive likelihood ratio
5.6 ( Heckerling PS et al. )
2.0 ( Gennis P et al. )
(average) 3.8
Negative likelihood ratio
0.8 ( Heckerling PS et al. )
1.0 ( Gennis P et al. )
(average) 0.9
Eichhoff's test
 De Quervain tenosynovitis
 Positive likelihood ratio
1.04 ( Goubau JF et al. )
(average) 1.04
Negative likelihood ratio
0.75 ( Goubau JF et al. )
(average) 0.75
Empty can test
 Rotator cuff injury
 Positive likelihood ratio
1.3 ( Hermans J et al. )
1.03 ( Penning L et al. )
(average) 1.17
Negative likelihood ratio
0.64 ( Hermans J et al. )
0.94 ( Penning L et al. )
(average) 0.79
 Subacromial impingement syndrome
 Positive likelihood ratio
1.82 ( Alqunaee M et al. )
3.90 ( Michener LA et al. )
(average) 2.86
Negative likelihood ratio
0.50 ( Alqunaee M et al. )
0.57 ( Michener LA et al. )
(average) 0.54
Enlarging
 Melanoma
 Positive likelihood ratio
11 ( Thomas L et al. )
(average) 11
Negative likelihood ratio
0.18 ( Thomas L et al. )
(average) 0.18
Epigastric pain
 Acute coronary syndrome
 Positive likelihood ratio
1.05 ( Rudi Bruyninckx et al. )
(average) 1.05
Negative likelihood ratio
0.98 ( Rudi Bruyninckx et al. )
(average) 0.98
Exacerbation by physical activity
 Migraine
 Positive likelihood ratio
3.7 ( Smetana GW et al. )
(average) 3.7
Negative likelihood ratio
0.24 ( Smetana GW et al. )
(average) 0.24
Exertional Pain
 Acute coronary syndrome
 Positive likelihood ratio
2.35 ( Goodacre S et al. )
(average) 2.35
Negative likelihood ratio
0.76 ( Goodacre S et al. )
(average) 0.76
Exudates
 Streptococcal pharyngitis
 Positive likelihood ratio
2.2 ( Aalbers J et al. )
(average) 2.2
Negative likelihood ratio
0.58 ( Aalbers J et al. )
(average) 0.58
Family history of allergic diseases
 Asthma in adults
 Positive likelihood ratio
1.53 ( Tomita K et al. )
(average) 1.53
Negative likelihood ratio
0.89 ( Tomita K et al. )
(average) 0.89
FAST test
 Stroke
 Positive likelihood ratio
2.66 ( Purrucker JC et al. )
1.33 ( Whiteley WN et al. )
1.88 ( Berglund A et al. )
6.00 ( Nor AM et al. )
4.82 ( London: Royal College of )
(average) 3.34
Negative likelihood ratio
0.22 ( Purrucker JC et al. )
0.49 ( Whiteley WN et al. )
0.31 ( Berglund A et al. )
0.51 ( Nor AM et al. )
0.22 ( London: Royal College of )
(average) 0.35
Fatigue - tired
 Upper respiratory infection
 Positive likelihood ratio
0.90 ( Nader Shaikh et al. )
(average) 0.9
Negative likelihood ratio
1.28 ( Nader Shaikh et al. )
(average) 1.28
 Mononucleosis
 Positive likelihood ratio
1.2 ( Mark H et al. )
(average) 1.2
Negative likelihood ratio
0.3 ( Mark H et al. )
(average) 0.3
 Hypothyroidism
 Positive likelihood ratio
1.96 ( Carle A et al. )
(average) 1.96
Negative likelihood ratio
0.33 ( Carle A et al. )
(average) 0.33
 HIV infection
 Positive likelihood ratio
2.6 ( Wood E et al. )
(average) 2.6
Negative likelihood ratio
0.85 ( Wood E et al. )
(average) 0.85
Femoral bruit
 Peripheral arterial disease
 Positive likelihood ratio
4.8 ( Khan NA et al. )
(average) 4.8
Negative likelihood ratio
0.83 ( Khan NA et al. )
(average) 0.83
FEV1 < 80
 Asthma in children
 Positive likelihood ratio
3.4 ( ITS Yu et al. )
(average) 3.4
Negative likelihood ratio
0.84 ( ITS Yu et al. )
(average) 0.84
Fever
 Upper respiratory infection
 Positive likelihood ratio
0.73 ( Nader Shaikh et al. )
(average) 0.73
Negative likelihood ratio
1.26 ( Nader Shaikh et al. )
(average) 1.26
 Mononucleosis
 Positive likelihood ratio
1.7 ( Mark H et al. )
(average) 1.7
Negative likelihood ratio
0.87 ( Mark H et al. )
(average) 0.87
 Streptococcal pharyngitis
 Positive likelihood ratio
1.65 ( Aalbers J et al. )
(average) 1.65
Negative likelihood ratio
0.71 ( Aalbers J et al. )
(average) 0.71
 Acute sinusitis
 Positive likelihood ratio
1.0 ( Claude Cyr et al. )
(average) 1
Negative likelihood ratio
1.0 ( Claude Cyr et al. )
(average) 1
 Cholecystitis
 Positive likelihood ratio
1.5 ( Trowbridge RL et al. )
(average) 1.5
Negative likelihood ratio
0.9 ( Trowbridge RL et al. )
(average) 0.9
 Otitis media acuta
 Positive likelihood ratio
0.8 ( R Rothman et al. )
0.77 ( Wood JM et al. )
(average) 0.79
Negative likelihood ratio
1.3 ( R Rothman et al. )
1.25 ( Wood JM et al. )
(average) 1.28
 Pneumonia in children
 Positive likelihood ratio
1.06 ( Rambaud-Althaus C et al. )
1.1 ( Shah SN et al. )
2.21 ( Zanco J et al. )
(average) 1.46
Negative likelihood ratio
0.53 ( Rambaud-Althaus C et al. )
0.59 ( Shah SN et al. )
0.23 ( Zanco J et al. )
(average) 0.45
 Urinary tract infection in women
 Positive likelihood ratio
1.25 ( Giesen LGM et al. )
1.6 ( Bent S et al. )
(average) 1.43
Negative likelihood ratio
0.98 ( Giesen LGM et al. )
0.9 ( Bent S et al. )
(average) 0.94
 Diverticulitis
 Positive likelihood ratio
1.4 ( Wilkins T et al. )
(average) 1.4
Negative likelihood ratio
0.8 ( Wilkins T et al. )
(average) 0.8
 Pneumonia in adults
 Positive likelihood ratio
2.73 ( Holm A et al. )
1.7 ( Heckerling PS et al. )
(average) 2.22
Negative likelihood ratio
0.79 ( Holm A et al. )
0.59 ( Heckerling PS et al. )
(average) 0.69
 Appendicitis
 Positive likelihood ratio
3.2 ( Wagner JM et al. )
1.06 ( Nshuti R et al. )
1.03 ( Idris SA et al. )
1.07 ( Al-gaithy Zuhoor K et )
(average) 1.59
Negative likelihood ratio
0.4 ( Wagner JM et al. )
0.99 ( Nshuti R et al. )
0.95 ( Idris SA et al. )
0.33 ( Al-gaithy Zuhoor K et )
(average) 0.67
 Temporal Arteritis
 Positive likelihood ratio
1.38 ( Ryan D et al. )
(average) 1.38
Negative likelihood ratio
0.90 ( Ryan D et al. )
(average) 0.9
Flexural complaints
 Atopic dermatitis
 Positive likelihood ratio
3.64 ( Sharma L et al. )
8.20 ( Wanitphakdeedecha R et al. )
(average) 5.92
Negative likelihood ratio
0.26 ( Sharma L et al. )
0.20 ( Wanitphakdeedecha R et al. )
(average) 0.23
Full can test
 Rotator cuff injury
 Positive likelihood ratio
2.4 ( Hermans J et al. )
(average) 2.4
Negative likelihood ratio
0.37 ( Hermans J et al. )
(average) 0.37
Genital ulcer
 HIV infection
 Positive likelihood ratio
5.4 ( Wood E et al. )
(average) 5.4
Negative likelihood ratio
0.99 ( Wood E et al. )
(average) 0.99
Glabella tap test
 Parkinson disease
 Positive likelihood ratio
4.5 ( Rao G et al. )
(average) 4.5
Negative likelihood ratio
0.13 ( Rao G et al. )
(average) 0.13
Groin pain
 Hip arthrosis
 Positive likelihood ratio
3.6 ( Sutlive TG et al. )
(average) 3.6
Negative likelihood ratio
0.78 ( Sutlive TG et al. )
(average) 0.78
Hair loss
 Hypothyroidism
 Positive likelihood ratio
3.50 ( Carle A et al. )
(average) 3.5
Negative likelihood ratio
0.76 ( Carle A et al. )
(average) 0.76
Hawkins test
 Rotator cuff injury
 Positive likelihood ratio
1.5 ( Hermans J et al. )
(average) 1.5
Negative likelihood ratio
0.51 ( Hermans J et al. )
(average) 0.51
 Subacromial impingement syndrome
 Positive likelihood ratio
1.23 ( Çalış M et al. )
1.72 ( Alqunaee M et al. )
1.63 ( Michener LA et al. )
(average) 1.53
Negative likelihood ratio
0.32 ( Çalış M et al. )
0.46 ( Alqunaee M et al. )
0.61 ( Michener LA et al. )
(average) 0.46
Head turning
 Epilepsy
 Positive likelihood ratio
13.47 ( Sheldon R et al. )
(average) 13.47
Negative likelihood ratio
0.59 ( Sheldon R et al. )
(average) 0.59
Headache
 Influenza during flu season
 Positive likelihood ratio
1.26 ( Ebell MH et al. )
(average) 1.26
Negative likelihood ratio
0.59 ( Ebell MH et al. )
(average) 0.59
 Upper respiratory infection
 Positive likelihood ratio
1.32 ( Nader Shaikh et al. )
(average) 1.32
Negative likelihood ratio
0.78 ( Nader Shaikh et al. )
(average) 0.78
 Mononucleosis
 Positive likelihood ratio
1.3 ( Mark H et al. )
(average) 1.3
Negative likelihood ratio
0.73 ( Mark H et al. )
(average) 0.73
 Hypothyroidism
 Positive likelihood ratio
1.32 ( Carle A et al. )
(average) 1.32
Negative likelihood ratio
0.94 ( Carle A et al. )
(average) 0.94
 HIV infection
 Positive likelihood ratio
2.1 ( Wood E et al. )
(average) 2.1
Negative likelihood ratio
0.9 ( Wood E et al. )
(average) 0.9
 Temporal Arteritis
 Positive likelihood ratio
1.22 ( Ryan D et al. )
0.91 ( Battista NA et al. )
(average) 1.07
Negative likelihood ratio
0.75 ( Ryan D et al. )
1.20 ( Battista NA et al. )
(average) 0.98
 Malignant brain tumor - primary
 Positive likelihood ratio
4.83 ( Hamilton W et al. )
(average) 4.83
(average) 0
Heart rate > 100 BPM
 Pneumonia in adults
 Positive likelihood ratio
2.50 ( Holm A et al. )
(average) 2.5
Negative likelihood ratio
0.83 ( Holm A et al. )
(average) 0.83
Hematuria - macroscopic
 Urinary tract infection in women
 Positive likelihood ratio
1.67 ( Giesen LGM et al. )
2.0 ( Bent S et al. )
(average) 1.84
Negative likelihood ratio
0.88 ( Giesen LGM et al. )
0.9 ( Bent S et al. )
(average) 0.89
Hemiparesis - ever
 Stroke
 Positive likelihood ratio
3.16 ( Sung VW et al. )
(average) 3.16
Negative likelihood ratio
0.49 ( Sung VW et al. )
(average) 0.49
Hirsutism
 Cushing syndrome
 Positive likelihood ratio
1.73 ( Nugent CA et al. )
(average) 1.73
Negative likelihood ratio
0.7 ( Nugent CA et al. )
(average) 0.7
Hypalgesia in median nerve territory
 Carpal tunnel syndrome
 Positive likelihood ratio
3.1 ( Christopher A et al. )
3.40 ( Kuhlman K et al. )
(average) 3.25
Negative likelihood ratio
0.7 ( Christopher A et al. )
0.58 ( Kuhlman K et al. )
(average) 0.64
Intercostal recession
 Pneumonia in children
 Positive likelihood ratio
1.76 ( Rambaud-Althaus C et al. )
(average) 1.76
Negative likelihood ratio
0.71 ( Rambaud-Althaus C et al. )
(average) 0.71
Intermittent claudication
 Spinal stenosis
 Positive likelihood ratio
3.7 ( Ebell MH et al. )
(average) 3.7
Negative likelihood ratio
0.23 ( Ebell MH et al. )
(average) 0.23
Irregular border
 Melanoma
 Positive likelihood ratio
2.0 ( Mark Ebell et al. )
2.1 ( Thomas L et al. )
(average) 2.05
Negative likelihood ratio
0.61 ( Mark Ebell et al. )
0.59 ( Thomas L et al. )
(average) 0.6
Irregular pulse - palpated
 Atrial fibrillation
 Positive likelihood ratio
4.58 ( Hobbs FD et al. )
(average) 4.58
Negative likelihood ratio
0.16 ( Hobbs FD et al. )
(average) 0.16
Itching
 Vaginal candidiasis
 Positive likelihood ratio
1.4 ( Anderson MR et al. )
(average) 1.4
Negative likelihood ratio
0.18 ( Anderson MR et al. )
(average) 0.18
 Atopic dermatitis
 Positive likelihood ratio
1.58 ( Sharma L et al. )
1.28 ( Wanitphakdeedecha R et al. )
(average) 1.43
Negative likelihood ratio
0.13 ( Sharma L et al. )
0.13 ( Wanitphakdeedecha R et al. )
(average) 0.13
Jaw claudication
 Temporal Arteritis
 Positive likelihood ratio
4.03 ( Ryan D et al. )
1.50 ( Battista NA et al. )
5.48 ( Diamantopoulos AP et al. )
(average) 3.67
Negative likelihood ratio
0.77 ( Ryan D et al. )
0.92 ( Battista NA et al. )
0.66 ( Diamantopoulos AP et al. )
(average) 0.78
Joint line tenderness
 Meniscal tear - acute
 Positive likelihood ratio
1.67 ( Kurosaka M et al. )
1.20 ( Fowler PJ et al. )
0.88 ( Shelbourne KD et al. )
(average) 1.25
Negative likelihood ratio
0.67 ( Kurosaka M et al. )
0.52 ( Fowler PJ et al. )
1.17 ( Shelbourne KD et al. )
(average) 0.79
Jolt accentuation
 Meningitis
 Positive likelihood ratio
1.46 ( Ala A et al. )
1.05 ( Mofidi M et al. )
(average) 1.26
Negative likelihood ratio
0.14 ( Ala A et al. )
0.91 ( Mofidi M et al. )
(average) 0.53
Kernig's sign
 Meningitis
 Positive likelihood ratio
1.00 ( Thomas KE et al. )
3.12 ( Ala A et al. )
1.59 ( Mofidi M et al. )
(average) 1.9
Negative likelihood ratio
1.00 ( Thomas KE et al. )
0.29 ( Ala A et al. )
0.79 ( Mofidi M et al. )
(average) 0.69
Lachman test
 Anterior cruciate ligament tear - chronic
 Positive likelihood ratio
7.1 ( Benjaminse A et al. )
(average) 7.1
Negative likelihood ratio
0.2 ( Benjaminse A et al. )
(average) 0.2
 Anterior cruciate ligament tear - acute
 Positive likelihood ratio
9.4 ( Benjaminse A et al. )
(average) 9.4
Negative likelihood ratio
0.1 ( Benjaminse A et al. )
(average) 0.1
Lacrimation during headache
 Cluster headache
 Positive likelihood ratio
99.55 ( Uluduz D et al. )
(average) 99.55
Negative likelihood ratio
0.46 ( Uluduz D et al. )
(average) 0.46
 Migraine
 Positive likelihood ratio
0.04 ( Uluduz D et al. )
(average) 0.04
Negative likelihood ratio
2.11 ( Uluduz D et al. )
(average) 2.11
Leg sensation abnormal
 Disc herniation
 Positive likelihood ratio
1.14 ( David S at al. )
(average) 1.14
Negative likelihood ratio
0.98 ( David S at al. )
(average) 0.98
Limb jerking
 Epilepsy
 Positive likelihood ratio
5.58 ( Sheldon R et al. )
(average) 5.58
Negative likelihood ratio
0.36 ( Sheldon R et al. )
(average) 0.36
Loss of balance
 Parkinson disease
 Positive likelihood ratio
1.6 ( Rao G et al. )
(average) 1.6
Negative likelihood ratio
0.29 ( Rao G et al. )
(average) 0.29
Lymphadenopathy - any
 HIV infection
 Positive likelihood ratio
3.1 ( Wood E et al. )
(average) 3.1
Negative likelihood ratio
0.7 ( Wood E et al. )
(average) 0.7
Malignant disease
 Deep venous thrombosis (DVT)
 Positive likelihood ratio
2.7 ( Goodacre S et al. )
(average) 2.7
Negative likelihood ratio
0.89 ( Goodacre S et al. )
(average) 0.89
McMurray's test
 Meniscal tear - acute
 Positive likelihood ratio
3,7 ( Rinonapoli G et al. )
8,29 ( Corea JR et al. )
8,00 ( Evans PJ et al. )
5,80 ( Fowler PJ et al. )
1,61 ( Kurosaka M et al. )
(average) 5
Negative likelihood ratio
0.2 ( Rinonapoli G et al. )
0.45 ( Corea JR et al. )
0.86 ( Evans PJ et al. )
0.75 ( Fowler PJ et al. )
0.82 ( Kurosaka M et al. )
(average) 0.62
Micrographia
 Parkinson disease
 Positive likelihood ratio
2.8 ( Rao G et al. )
(average) 2.8
Negative likelihood ratio
0.3 ( Rao G et al. )
(average) 0.3
Migration of pain
 Appendicitis
 Positive likelihood ratio
3.6 ( Wagner JM et al. )
3.2 ( Hardin M et al. )
(average) 3.4
Negative likelihood ratio
0.4 ( Wagner JM et al. )
0.5 ( Hardin M et al. )
(average) 0.45
MMSE < 27
 Dementia
 Positive likelihood ratio
6.00 ( Mitchell AJ et al. )
3.03 ( Eefsting JA et al. )
(average) 4.52
Negative likelihood ratio
0.25 ( Mitchell AJ et al. )
0.17 ( Eefsting JA et al. )
(average) 0.21
Morning stiffness
 Rheumatoid arthritis
 Positive likelihood ratio
1.52 ( Arnett FC et al. )
(average) 1.52
Negative likelihood ratio
0.22 ( Arnett FC et al. )
(average) 0.22
Murphy's sign
 Cholecystitis
 Positive likelihood ratio
2.8 ( Trowbridge RL et al. )
5.0 ( Abraham S et al. )
1.24 ( Hwang H et al. )
(average) 3.01
Negative likelihood ratio
0.5 ( Trowbridge RL et al. )
0.4 ( Abraham S et al. )
0.71 ( Hwang H et al. )
(average) 0.54
Myalgia
 Influenza during flu season
 Positive likelihood ratio
1.26 ( Ebell MH et al. )
(average) 1.26
Negative likelihood ratio
0.60 ( Ebell MH et al. )
(average) 0.6
 Temporal Arteritis
 Positive likelihood ratio
1.24 ( Ryan D et al. )
(average) 1.24
Negative likelihood ratio
0.80 ( Ryan D et al. )
(average) 0.8
Myocardial infarction in history
 Heart failure
 Positive likelihood ratio
4.33 ( Morgan S et al. )
(average) 4.33
Negative likelihood ratio
0.67 ( Morgan S et al. )
(average) 0.67
Nasal congestion
 Influenza during flu season
 Positive likelihood ratio
1.21 ( Ebell MH et al. )
(average) 1.21
Negative likelihood ratio
0.71 ( Ebell MH et al. )
(average) 0.71
 Atopic dermatitis
 Positive likelihood ratio
1.33 ( Wanitphakdeedecha R et al. )
2.33 ( Sharma L et al. )
(average) 1.83
Negative likelihood ratio
0.86 ( Wanitphakdeedecha R et al. )
0.87 ( Sharma L et al. )
(average) 0.87
 Acute sinusitis
 Positive likelihood ratio
1.18 ( Moore P et al. )
(average) 1.18
Negative likelihood ratio
0.86 ( Moore P et al. )
(average) 0.86
Nasal flaring
 Pneumonia in children
 Positive likelihood ratio
1,75 ( Rambaud-Althaus C et al. )
2.2 ( Shah SN et al. )
(average) 1.6
Negative likelihood ratio
0.73 ( Rambaud-Althaus C et al. )
0.77 ( Shah SN et al. )
(average) 0.75
Nausea
 Cholecystitis
 Positive likelihood ratio
1.1 ( Trowbridge RL et al. )
(average) 1.1
Negative likelihood ratio
0.8 ( Trowbridge RL et al. )
(average) 0.8
 Cholelithiasis
 Positive likelihood ratio
1.2 ( Abraham S et al. )
(average) 1.2
Negative likelihood ratio
0.74 ( Abraham S et al. )
(average) 0.74
 HIV infection
 Positive likelihood ratio
3.2 ( Wood E et al. )
(average) 3.2
Negative likelihood ratio
0.97 ( Wood E et al. )
(average) 0.97
 Appendicitis
 Positive likelihood ratio
7.00 ( Idris SA et al. )
(average) 7
Negative likelihood ratio
0.10 ( Idris SA et al. )
(average) 0.1
 Migraine
 Positive likelihood ratio
19.2 ( Smetana GW et al. )
(average) 19.2
Negative likelihood ratio
0.20 ( Smetana GW et al. )
(average) 0.2
 Cluster headache
 Positive likelihood ratio
2.01 ( Uluduz D et al. )
(average) 2.01
Negative likelihood ratio
0.76 ( Uluduz D et al. )
(average) 0.76
 Acute coronary syndrome
 Positive likelihood ratio
1.88 ( Mant J et al. )
(average) 1.88
Negative likelihood ratio
0.77 ( Mant J et al. )
(average) 0.77
Nocturia
 Urinary tract infection in women
 Positive likelihood ratio
1.31 ( Giesen LGM et al. )
(average) 1.31
Negative likelihood ratio
0.75 ( Giesen LGM et al. )
(average) 0.75
Nocturnal paresthesia
 Carpal tunnel syndrome
 Positive likelihood ratio
1.6 ( Christopher A et al. )
(average) 1.6
Negative likelihood ratio
0.7 ( Christopher A et al. )
(average) 0.7
Nuchal rigidity
 Meningitis
 Positive likelihood ratio
0.94 ( Thomas KE et al. )
2.5 ( Mofidi M et al. )
(average) 1.72
Negative likelihood ratio
1.03 ( Thomas KE et al. )
0.45 ( Mofidi M et al. )
(average) 0.74
Observed unresponsiveness
 Epilepsy
 Positive likelihood ratio
3.05 ( Sheldon R et al. )
(average) 3.05
Negative likelihood ratio
0.31 ( Sheldon R et al. )
(average) 0.31
Ocular itch
 Allergic rhinitis
 Positive likelihood ratio
2.06 ( Kim H et al. )
(average) 2.06
Negative likelihood ratio
0.52 ( Kim H et al. )
(average) 0.52
Oral ulcer
 HIV infection
 Positive likelihood ratio
3.4 ( Wood E et al. )
(average) 3.4
Negative likelihood ratio
0.91 ( Wood E et al. )
(average) 0.91
Other allergic diseases
 Asthma in adults
 Positive likelihood ratio
1.72 ( Tomita K et al. )
(average) 1.72
Negative likelihood ratio
0.66 ( Tomita K et al. )
(average) 0.66
Pain in left arm
 Acute coronary syndrome
 Positive likelihood ratio
1.3 ( Rudi Bruyninckx et al. )
(average) 1.3
Negative likelihood ratio
0.88 ( Rudi Bruyninckx et al. )
(average) 0.88
Pain on motion in ankles
 Rheumatoid arthritis
 Positive likelihood ratio
2.19 ( Arnett FC et al. )
(average) 2.19
Negative likelihood ratio
0.46 ( Arnett FC et al. )
(average) 0.46
Pain on motion in DIPs
 Rheumatoid arthritis
 Positive likelihood ratio
1.00 ( Arnett FC et al. )
(average) 1
Negative likelihood ratio
1.00 ( Arnett FC et al. )
(average) 1
Pain on motion in elbows
 Rheumatoid arthritis
 Positive likelihood ratio
2.37 ( Arnett FC et al. )
(average) 2.37
Negative likelihood ratio
0.49 ( Arnett FC et al. )
(average) 0.49
Pain on motion in hips
 Rheumatoid arthritis
 Positive likelihood ratio
1.09 ( Arnett FC et al. )
(average) 1.09
Negative likelihood ratio
0.96 ( Arnett FC et al. )
(average) 0.96
Pain on motion in knees
 Rheumatoid arthritis
 Positive likelihood ratio
1.25 ( Arnett FC et al. )
(average) 1.25
Negative likelihood ratio
0.56 ( Arnett FC et al. )
(average) 0.56
Pain on motion in MCPs
 Rheumatoid arthritis
 Positive likelihood ratio
2.67 ( Arnett FC et al. )
(average) 2.67
Negative likelihood ratio
0.18 ( Arnett FC et al. )
(average) 0.18
Pain on motion in PIPs
 Rheumatoid arthritis
 Positive likelihood ratio
2.15 ( Arnett FC et al. )
(average) 2.15
Negative likelihood ratio
0.23 ( Arnett FC et al. )
(average) 0.23
Pain on motion in shoulders
 Rheumatoid arthritis
 Positive likelihood ratio
1.71 ( Arnett FC et al. )
(average) 1.71
Negative likelihood ratio
0.42 ( Arnett FC et al. )
(average) 0.42
Pain on motion in wrists
 Rheumatoid arthritis
 Positive likelihood ratio
2.50 ( Arnett FC et al. )
(average) 2.5
Negative likelihood ratio
0.16 ( Arnett FC et al. )
(average) 0.16
Pain valgus stress 30°
 Medial Collateral Ligament Lesion
 Positive likelihood ratio
2.3 ( Kastelein M et al. )
(average) 2.3
Negative likelihood ratio
0.3 ( Kastelein M et al. )
(average) 0.3
Painful arc
 Rotator cuff injury
 Positive likelihood ratio
3.7 ( Hermans J et al. )
(average) 3.7
Negative likelihood ratio
0.36 ( Hermans J et al. )
(average) 0.36
 Subacromial impingement syndrome
 Positive likelihood ratio
1.60 ( Çalış M et al. )
2.25 ( Michener LA et al. )
(average) 1.93
Negative likelihood ratio
0.85 ( Çalış M et al. )
0.38 ( Michener LA et al. )
(average) 0.62
Palatal petechiae
 Mononucleosis
 Positive likelihood ratio
5.4 ( Mark H et al. )
(average) 5.4
Negative likelihood ratio
0.77 ( Mark H et al. )
(average) 0.77
Palpable pulse abnormality
 Peripheral arterial disease
 Positive likelihood ratio
4.7 ( Khan NA et al. )
(average) 4.7
Negative likelihood ratio
0.38 ( Khan NA et al. )
(average) 0.38
Palpable thyroid
 Graves disease
 Positive likelihood ratio
2.3 ( Peterson S et al. )
(average) 2.3
Negative likelihood ratio
0.6 ( Peterson S et al. )
(average) 0.6
Palpitations
 Hypothyroidism
 Positive likelihood ratio
1.70 ( Carle A et al. )
(average) 1.7
Negative likelihood ratio
0.82 ( Carle A et al. )
(average) 0.82
Passive lumbar extension test
 Spondylolysis
 Positive likelihood ratio
8.84 ( Ferrari S et al. )
(average) 8.84
Negative likelihood ratio
0.18 ( Ferrari S et al. )
(average) 0.18
Phonophobia
 Migraine
 Positive likelihood ratio
5.2 ( Smetana GW et al. )
(average) 5.2
Negative likelihood ratio
0.38 ( Smetana GW et al. )
(average) 0.38
 Cluster headache
 Positive likelihood ratio
2.32 ( Uluduz D et al. )
(average) 2.32
Negative likelihood ratio
0.71 ( Uluduz D et al. )
(average) 0.71
Photophobia
 Migraine
 Positive likelihood ratio
5.8 ( Smetana GW et al. )
(average) 5.8
Negative likelihood ratio
0.25 ( Smetana GW et al. )
(average) 0.25
 Cluster headache
 Positive likelihood ratio
2.09 ( Uluduz D et al. )
(average) 2.09
Negative likelihood ratio
0.78 ( Uluduz D et al. )
(average) 0.78
Pivot shift
 Anterior cruciate ligament tear - chronic
 Positive likelihood ratio
7.7 ( Benjaminse A et al. )
(average) 7.7
Negative likelihood ratio
0.8 ( Benjaminse A et al. )
(average) 0.8
 Anterior cruciate ligament tear - acute
 Positive likelihood ratio
1.3 ( Benjaminse A et al. )
(average) 1.3
Negative likelihood ratio
1.0 ( Benjaminse A et al. )
(average) 1
Polakysuria
 Urinary tract infection in women
 Positive likelihood ratio
1.10 ( Giesen LGM et al. )
(average) 1.1
Negative likelihood ratio
0.60 ( Giesen LGM et al. )
(average) 0.6
 Acute coronary syndrome
 Positive likelihood ratio
1.8 ( Rudi Bruyninckx et al. )
(average) 1.8
Negative likelihood ratio
0.6 ( Rudi Bruyninckx et al. )
(average) 0.6
Posterior drawer test
 Posterior cruciate ligament tear
 Positive likelihood ratio
90.00 ( Rubinstein RA et al. )
(average) 90
Negative likelihood ratio
0.10 ( Rubinstein RA et al. )
(average) 0.1
Postictal headache
 Epilepsy
 Positive likelihood ratio
2.99 ( Sheldon R et al. )
(average) 2.99
Negative likelihood ratio
0.61 ( Sheldon R et al. )
(average) 0.61
Prodromal trembling
 Epilepsy
 Positive likelihood ratio
4.98 ( Sheldon R et al. )
(average) 4.98
Negative likelihood ratio
0.75 ( Sheldon R et al. )
(average) 0.75
Psoas sign
 Appendicitis
 Positive likelihood ratio
3.2 ( Wagner JM et al. )
1.06 ( Idris SA et al. )
(average) 2.13
Negative likelihood ratio
0.9 ( Wagner JM et al. )
0.86 ( Idris SA et al. )
(average) 0.88
Radiating pain
 Cholelithiasis
 Positive likelihood ratio
1.6 ( Abraham S et al. )
(average) 1.6
Negative likelihood ratio
0.62 ( Abraham S et al. )
(average) 0.62
Rebound tenderness
 Appendicitis
 Positive likelihood ratio
3.0 ( David G. Bundy et )
2.41 ( Lamture YR et al. )
(average) 2.71
Negative likelihood ratio
0.28 ( David G. Bundy et )
0.48 ( Lamture YR et al. )
(average) 0.38
 Cholecystitis
 Positive likelihood ratio
1.9 ( Trowbridge RL et al. )
1.7 ( Abraham S et al. )
(average) 1.8
Negative likelihood ratio
0.75 ( Trowbridge RL et al. )
0.43 ( Abraham S et al. )
(average) 0.59
 Small bowel obstruction
 Positive likelihood ratio
5.1 ( Bohner H et al. )
(average) 5.1
Negative likelihood ratio
0.7 ( Bohner H et al. )
(average) 0.7
 Cholelithiasis
 Positive likelihood ratio
1.3 ( Abraham S et al. )
(average) 1.3
Negative likelihood ratio
0.73 ( Abraham S et al. )
(average) 0.73
Recent immobilization
 Deep venous thrombosis (DVT)
 Positive likelihood ratio
2.3 ( Goodacre S et al. )
(average) 2.3
Negative likelihood ratio
0.90 ( Goodacre S et al. )
(average) 0.9
Recent surgery
 Deep venous thrombosis (DVT)
 Positive likelihood ratio
1.8 ( Goodacre S et al. )
(average) 1.8
Negative likelihood ratio
0.94 ( Goodacre S et al. )
(average) 0.94
Red tympanic membrane
 Otitis media acuta
 Positive likelihood ratio
1.1 ( Sandi Pirozzo et al. )
(average) 1.1
Negative likelihood ratio
0.98 ( Sandi Pirozzo et al. )
(average) 0.98
Reporting history of this allergy
 B-lactam allergy
 Positive likelihood ratio
1.9 ( Salkind AR et al. )
2.37 ( Sodhi M et al. )
(average) 2.14
Negative likelihood ratio
0.5 ( Salkind AR et al. )
0.94 ( Sodhi M et al. )
(average) 0.72
Rhinorrhea
 Acute sinusitis
 Positive likelihood ratio
1.3 ( Claude Cyr et al. )
1.28 ( Moore P et al. )
(average) 1.29
Negative likelihood ratio
0.8 ( Claude Cyr et al. )
0.63 ( Moore P et al. )
(average) 0.72
 Otitis media acuta
 Positive likelihood ratio
1.3 ( R Rothman et al. )
(average) 1.3
Negative likelihood ratio
0.6 ( R Rothman et al. )
(average) 0.6
 Allergic rhinitis
 Positive likelihood ratio
1.76 ( Kim H et al. )
(average) 1.76
Negative likelihood ratio
0.53 ( Kim H et al. )
(average) 0.53
Right lower quadrant pain
 Appendicitis
 Positive likelihood ratio
1.2 ( David G. Bundy et )
8.0 ( Hardin M et al. )
1.12 ( Idris SA et al. )
(average) 3.44
Negative likelihood ratio
0.56 ( David G. Bundy et )
0.28 ( Hardin M et al. )
0.29 ( Idris SA et al. )
(average) 0.38
Right upper quadrant pain
 Cholecystitis
 Positive likelihood ratio
1.5 ( Trowbridge RL et al. )
2.5 ( Abraham S et al. )
(average) 2
Negative likelihood ratio
0.7 ( Trowbridge RL et al. )
0.28 ( Abraham S et al. )
(average) 0.49
 Cholelithiasis
 Positive likelihood ratio
1.2 ( Abraham S et al. )
(average) 1.2
Negative likelihood ratio
0.74 ( Abraham S et al. )
(average) 0.74
Rigidity
 Parkinson disease
 Positive likelihood ratio
4.5 ( Rao G et al. )
(average) 4.5
Negative likelihood ratio
0.12 ( Rao G et al. )
(average) 0.12
Seasonality
 Allergic rhinitis
 Positive likelihood ratio
0.95 ( Kim H et al. )
(average) 0.95
Negative likelihood ratio
1.22 ( Kim H et al. )
(average) 1.22
Shuffling gait
 Parkinson disease
 Positive likelihood ratio
3.3 ( Rao G et al. )
(average) 3.3
Negative likelihood ratio
0.32 ( Rao G et al. )
(average) 0.32
Slump test
 Disc herniation
 Positive likelihood ratio
4.94 ( Majlesi J et al. )
1.22 ( Ekedahl H et al. )
(average) 3.08
Negative likelihood ratio
0.19 ( Majlesi J et al. )
0.61 ( Ekedahl H et al. )
(average) 0.4
Smoking
 COPD
 Positive likelihood ratio
1.8 ( Dewar M et al. )
(average) 1.8
Negative likelihood ratio
0.16 ( Dewar M et al. )
(average) 0.16
 Acute sinusitis
 Positive likelihood ratio
1.38 ( Moore P et al. )
(average) 1.38
Negative likelihood ratio
0.97 ( Moore P et al. )
(average) 0.97
Soap intolerance
 Atopic dermatitis
 Positive likelihood ratio
3.40 ( Sharma L et al. )
1.69 ( Wanitphakdeedecha R et al. )
(average) 2.55
Negative likelihood ratio
0.73 ( Sharma L et al. )
0.68 ( Wanitphakdeedecha R et al. )
(average) 0.71
Sore throat
 Influenza during flu season
 Positive likelihood ratio
1.06 ( Ebell MH et al. )
(average) 1.06
Negative likelihood ratio
0.89 ( Ebell MH et al. )
(average) 0.89
Sores
 Peripheral arterial disease
 Positive likelihood ratio
5.9 ( Khan NA et al. )
(average) 5.9
Negative likelihood ratio
0.98 ( Khan NA et al. )
(average) 0.98
Splenomegaly
 Mononucleosis
 Positive likelihood ratio
7.0 ( Mark H et al. )
(average) 7
Negative likelihood ratio
0.94 ( Mark H et al. )
(average) 0.94
SpO2 < 90%
 COPD
 Positive likelihood ratio
6.77 ( Amalakanti S et al. )
(average) 6.77
Negative likelihood ratio
0.18 ( Amalakanti S et al. )
(average) 0.18
SpO2 < 95%
 COPD
 Positive likelihood ratio
2.82 ( Pachon EG et al. )
(average) 2.82
Negative likelihood ratio
0.78 ( Pachon EG et al. )
(average) 0.78
 Pneumonia in adults
 Positive likelihood ratio
1.83 ( Moore M et al. )
2.6 ( Holm A et al. )
(average) 2.22
Negative likelihood ratio
0.87 ( Moore M et al. )
0.60 ( Holm A et al. )
(average) 0.74
 Pneumonia in children
 Positive likelihood ratio
3.5 ( Shah SN et al. )
(average) 3.5
Negative likelihood ratio
0.88 ( Shah SN et al. )
(average) 0.88
Sputum
 Influenza during flu season
 Positive likelihood ratio
1.13 ( Ebell MH et al. )
(average) 1.13
Negative likelihood ratio
0.94 ( Ebell MH et al. )
(average) 0.94
 Asthma in children
 Positive likelihood ratio
1.7 ( ITS Yu et al. )
(average) 1.7
Negative likelihood ratio
0.69 ( ITS Yu et al. )
(average) 0.69
Squat causing posterior pain
 Hip arthrosis
 Positive likelihood ratio
6.1 ( Sutlive TG et al. )
(average) 6.1
Negative likelihood ratio
0.79 ( Sutlive TG et al. )
(average) 0.79
Straight Leg Raising test
 Disc herniation
 Positive likelihood ratio
4.73 ( Majlesi J et al. )
6.38 ( Omar S et al. )
4.40 ( Cecin AH Cecin's Sign: )
2.1 ( Deville WL et al. )
(average) 4.4
Negative likelihood ratio
0.54 ( Majlesi J et al. )
0.20 ( Omar S et al. )
0.82 ( Cecin AH Cecin's Sign: )
0.21 ( Deville WL et al. )
(average) 0.44
Striae
 Cushing syndrome
 Positive likelihood ratio
2.1 ( Nugent CA et al. )
(average) 2.1
Negative likelihood ratio
0.69 ( Nugent CA et al. )
(average) 0.69
Swallowing complaints
 Hypothyroidism
 Positive likelihood ratio
2.59 ( Carle A et al. )
(average) 2.59
Negative likelihood ratio
0.80 ( Carle A et al. )
(average) 0.8
Sweating
 Influenza during flu season
 Positive likelihood ratio
2.86 ( Ebell MH et al. )
(average) 2.86
Negative likelihood ratio
0.63 ( Ebell MH et al. )
(average) 0.63
 Acute coronary syndrome
 Positive likelihood ratio
1.34 ( Rudi Bruyninckx et al. )
2.06 ( Mant J et al. )
(average) 1.7
Negative likelihood ratio
0.85 ( Rudi Bruyninckx et al. )
0.65 ( Mant J et al. )
(average) 0.75
 Hypothyroidism
 Positive likelihood ratio
3.86 ( Zulewski H et al. )
(average) 3.86
Negative likelihood ratio
0.53 ( Zulewski H et al. )
(average) 0.53
Swelling in ankles
 Rheumatoid arthritis
 Positive likelihood ratio
4.42 ( Arnett FC et al. )
(average) 4.42
Negative likelihood ratio
0.53 ( Arnett FC et al. )
(average) 0.53
Swelling in DIPs
 Rheumatoid arthritis
 Positive likelihood ratio
4.65 ( Arnett FC et al. )
(average) 4.65
Negative likelihood ratio
0.25 ( Arnett FC et al. )
(average) 0.25
Swelling in elbows
 Rheumatoid arthritis
 Positive likelihood ratio
4.20 ( Arnett FC et al. )
(average) 4.2
Negative likelihood ratio
0.64 ( Arnett FC et al. )
(average) 0.64
Swelling in knees
 Rheumatoid arthritis
 Positive likelihood ratio
2.21 ( Arnett FC et al. )
(average) 2.21
Negative likelihood ratio
0.51 ( Arnett FC et al. )
(average) 0.51
Swelling in MCPs
 Rheumatoid arthritis
 Positive likelihood ratio
5.37 ( Arnett FC et al. )
(average) 5.37
Negative likelihood ratio
0.17 ( Arnett FC et al. )
(average) 0.17
Swelling in PIPs
 Rheumatoid arthritis
 Positive likelihood ratio
4.94 ( Arnett FC et al. )
(average) 4.94
Negative likelihood ratio
0.25 ( Arnett FC et al. )
(average) 0.25
Swelling in wrists
 Rheumatoid arthritis
 Positive likelihood ratio
5.71 ( Arnett FC et al. )
(average) 5.71
Negative likelihood ratio
0.23 ( Arnett FC et al. )
(average) 0.23
Systolic murmur
 Aortic stenosis
 Positive likelihood ratio
3.50 ( Iversen K et al. )
3.21 ( Parras J et al. )
(average) 3.36
Negative likelihood ratio
0.66 ( Iversen K et al. )
0.32 ( Parras J et al. )
(average) 0.49
 Atrial septum defect
 Positive likelihood ratio
1.22 ( Iversen K et al. )
(average) 1.22
Negative likelihood ratio
0.98 ( Iversen K et al. )
(average) 0.98
 Mitral insufficiency
 Positive likelihood ratio
1.36 ( Iversen K et al. )
(average) 1.36
Negative likelihood ratio
0.94 ( Iversen K et al. )
(average) 0.94
 Aortic insufficiency
 Positive likelihood ratio
1.3 ( Choudhry NK et al. )
(average) 1.3
Negative likelihood ratio
0.5 ( Choudhry NK et al. )
(average) 0.5
 Heart failure
 Positive likelihood ratio
2.6 ( Wang CS et al. )
(average) 2.6
Negative likelihood ratio
0.81 ( Wang CS et al. )
(average) 0.81
Temporal artery pain
 Temporal Arteritis
 Positive likelihood ratio
2.26 ( Ryan D et al. )
(average) 2.26
Negative likelihood ratio
0.64 ( Ryan D et al. )
(average) 0.64
Throbbing or pulsating pain
 Migraine
 Positive likelihood ratio
2.9 ( Smetana GW et al. )
(average) 2.9
Negative likelihood ratio
0.36 ( Smetana GW et al. )
(average) 0.36
 Tension type headache
 Positive likelihood ratio
0.34 ( Pacheva IH et al. )
(average) 0.34
Negative likelihood ratio
3.65 ( Pacheva IH et al. )
(average) 3.65
Tinel's test
 Ulnar neuropathy
 Positive likelihood ratio
1.32 ( Beekman R et al. )
(average) 1.32
Negative likelihood ratio
0.72 ( Beekman R et al. )
(average) 0.72
Tremor
 Parkinson disease
 Positive likelihood ratio
1.4 ( Rao G et al. )
(average) 1.4
Negative likelihood ratio
0.54 ( Rao G et al. )
(average) 0.54
Trendelenburg test
 Hip arthrosis
 Positive likelihood ratio
1.83 ( Youdas JW et al. )
(average) 1.83
Negative likelihood ratio
0.64 ( Youdas JW et al. )
(average) 0.64
Two or more colors
 Melanoma
 Positive likelihood ratio
1.6 ( Mark Ebell et al. )
1.6 ( Thomas L et al. )
(average) 1.6
Negative likelihood ratio
0.59 ( Mark Ebell et al. )
0.59 ( Thomas L et al. )
(average) 0.59
Ulnar nerve compression
 Ulnar neuropathy
 Positive likelihood ratio
44.50 ( Novak CB et al. )
(average) 44.5
Negative likelihood ratio
0.11 ( Novak CB et al. )
(average) 0.11
Unilateral pain
 Migraine
 Positive likelihood ratio
3.7 ( Smetana GW et al. )
(average) 3.7
Negative likelihood ratio
0.43 ( Smetana GW et al. )
(average) 0.43
 Tension type headache
 Positive likelihood ratio
0.61 ( Pacheva IH et al. )
(average) 0.61
Negative likelihood ratio
10.25 ( Pacheva IH et al. )
(average) 10.25
Unilateral paresthesia - ever
 Stroke
 Positive likelihood ratio
2.71 ( Sung VW et al. )
(average) 2.71
(average) 0
Urgency - miction
 Urinary tract infection in women
 Positive likelihood ratio
1.22 ( Giesen LGM et al. )
(average) 1.22
(average) 0
Urinary symptoms
 Spinal stenosis
 Positive likelihood ratio
7 ( Ebell MH et al. )
(average) 7
Negative likelihood ratio
0.14 ( Ebell MH et al. )
(average) 0.14
Vaginal discharge
 Urinary tract infection in women
 Positive likelihood ratio
0.65 ( Giesen LGM et al. )
0.3 ( Bent S et al. )
(average) 0.48
Negative likelihood ratio
1.10 ( Giesen LGM et al. )
3.1 ( Bent S et al. )
(average) 2.1
Valsalva's maneuver
 Heart failure
 Positive likelihood ratio
7.67 ( Shamsham S et al. )
(average) 7.67
Negative likelihood ratio
0.34 ( Shamsham S et al. )
(average) 0.34
Verbal fluency test < 15
 Dementia
 Positive likelihood ratio
22.00 ( Simmons BB et al. )
(average) 22
Negative likelihood ratio
0.13 ( Simmons BB et al. )
(average) 0.13
Vomiting
 Acute coronary syndrome
 Positive likelihood ratio
1.32 ( Rudi Bruyninckx et al. )
(average) 1.32
Negative likelihood ratio
0.93 ( Rudi Bruyninckx et al. )
(average) 0.93
 Cholecystitis
 Positive likelihood ratio
1.5 ( Trowbridge RL et al. )
(average) 1.5
Negative likelihood ratio
0.6 ( Trowbridge RL et al. )
(average) 0.6
 Small bowel obstruction
 Positive likelihood ratio
2.2 ( Bohner H et al. )
(average) 2.2
Negative likelihood ratio
0.4 ( Bohner H et al. )
(average) 0.4
 Diverticulitis
 Positive likelihood ratio
1.4 ( Wilkins T et al. )
(average) 1.4
Negative likelihood ratio
0.2 ( Wilkins T et al. )
(average) 0.2
 HIV infection
 Positive likelihood ratio
4.6 ( Wood E et al. )
(average) 4.6
Negative likelihood ratio
0.9 ( Wood E et al. )
(average) 0.9
 Appendicitis
 Positive likelihood ratio
1.31 ( Idris SA et al. )
1.09 ( Al-gaithy Zuhoor K et )
(average) 1.2
Negative likelihood ratio
0.56 ( Idris SA et al. )
0.38 ( Al-gaithy Zuhoor K et )
(average) 0.47
 Cluster headache
 Positive likelihood ratio
1.85 ( Uluduz D et al. )
(average) 1.85
Negative likelihood ratio
0.90 ( Uluduz D et al. )
(average) 0.9
Walking heel-to-toe impaired
 Parkinson disease
 Positive likelihood ratio
2.9 ( Rao G et al. )
(average) 2.9
Negative likelihood ratio
0.32 ( Rao G et al. )
(average) 0.32
Weak ankle dorsiflexion
 Disc herniation
 Positive likelihood ratio
4.9 ( David S at al. )
(average) 4.9
Negative likelihood ratio
0.5 ( David S at al. )
(average) 0.5
WHAT test
 De Quervain tenosynovitis
 Positive likelihood ratio
1.39 ( Goubau JF et al. )
(average) 1.39
Negative likelihood ratio
0.04 ( Goubau JF et al. )
(average) 0.04
Wheezing
 Asthma in children
 Positive likelihood ratio
8.1 ( ITS Yu et al. )
(average) 8.1
Negative likelihood ratio
0.44 ( ITS Yu et al. )
(average) 0.44
 Asthma in adults
 Positive likelihood ratio
2.29 ( Tomita K et al. )
(average) 2.29
Negative likelihood ratio
0.80 ( Tomita K et al. )
(average) 0.8
 COPD
 Positive likelihood ratio
3.8 ( Dewar M et al. )
(average) 3.8
Negative likelihood ratio
0.66 ( Dewar M et al. )
(average) 0.66
 Hypothyroidism
 Positive likelihood ratio
2.20 ( Carle A et al. )
(average) 2.2
Negative likelihood ratio
0.83 ( Carle A et al. )
(average) 0.83
Wheezing on examination
 COPD
 Positive likelihood ratio
36 ( Dewar M et al. )
(average) 36
Negative likelihood ratio
0.85 ( Dewar M et al. )
(average) 0.85
 Pneumonia in children
 Positive likelihood ratio
0.95 ( Zanco J et al. )
(average) 0.95
Negative likelihood ratio
3.50 ( Zanco J et al. )
(average) 3.5
Xerosis
 Atopic dermatitis
 Positive likelihood ratio
2.55 ( Sharma L et al. )
1.65 ( Wanitphakdeedecha R et al. )
(average) 2.1
Negative likelihood ratio
0.30 ( Sharma L et al. )
0.51 ( Wanitphakdeedecha R et al. )
(average) 0.41
Yellow discharge
 Trichomoniasis vaginalis
 Positive likelihood ratio
4.1 ( Anderson MR et al. )
(average) 4.1
Negative likelihood ratio
0.12 ( Anderson MR et al. )
(average) 0.12