Larry B. Goldstein, MD
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1332.
Requests for Single Reprints: Larry B. Goldstein, MD, Box 3651, Duke University Medical Center, Durham, NC 27710; e-mail, email@example.com.
This article was published online first at www.annals.org on 8 July 2014.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Earl W. Ferguson, MD, PhD, FACC, FACP, FACPM
Ridgecrest Regional Hospital
July 7, 2014
What's wrong with carotid auscultation as the preferred diagnostic tool?
I check the carotid pulse and listen for carotid bruits on every patient and have found many significant carotid stenoses the were asymptomatic and required intervention. I concur with the recommendations in this Annals issue. Have we forgotten that the best way we can do a cost-effective and efficient screening for carotid stenoses is with a good physical exam that always includes auscultation of the carotids?
David L Keller, MD
July 8, 2014
You cannot concur and still perform the exam they advise against
First, I concur with you, Dr. Ferguson when you advocate listening for carotid bruits in asymptomatic patients to screen for carotid stenosis.However, I would point out that you are thereby acting in direct opposition to the advice by the USPSTF not to screen asymptomatic patients, which means you do not "concur" with them.You and I need to admit to ourselves that we disagree with the 16 primary care physicians on the USPSTF. They are using obsolete data from studies which did not employ high-dose statins as a treatment option for the systemic condition known as atherosclerosis.
Goldstein LB. Screening for Asymptomatic Carotid Artery Stenosis: Caveat Emptor. Ann Intern Med. 2014;161:370–371. doi: 10.7326/M14-1332
Download citation file:
Published: Ann Intern Med. 2014;161(5):370-371.
Neurology, Prevention/Screening, Stroke.
Results provided by:
Copyright © 2017 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only