{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T16:52:34Z","timestamp":1772211154862,"version":"3.50.1"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,6,20]],"date-time":"2021-06-20T00:00:00Z","timestamp":1624147200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,20]],"date-time":"2021-06-20T00:00:00Z","timestamp":1624147200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006389","name":"Universit\u00e9 de Gen\u00e8ve","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006389","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Intern Emerg Med"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Physical examination (PE) has always been a corner stone of medical practice. The recent advances in imaging and fading of doctors\u2019 ability in performing it, however, raised doubts on PE usefulness. Point-of-care ultrasonography (POCUS) is gaining ground in medicine with the detection of free fluids being one of its main applications. To estimate physicians\u2019 confidence and use of PE and POCUS for the detection of abdominal or pleural free fluid, we conducted a cross-sectional survey. In all, 246 internal and emergency medicine physicians answered to the survey (197 in-hospital physicians and 49 general practitioners; response rate 28.5%). Almost all declared to perform PE in case of suspected ascites or pleural effusion (88% and 90%, respectively). The highest rates of confidence were observed in conventional PE signs (91% for diminished breath sounds, 80% for dullness to thorax percussion, and 66% for abdominal flank dullness). For the remaining signs, rates of confidence were less than 53%. Physicians with\u2009&gt;\u200915\u00a0years of experience and POCUS-na\u00efve doctors reported higher confidence in PE. Most of emergency and almost half of internal medicine physicians (78% and 44%, respectively) attended a structured POCUS course. POCUS use was higher among trained physicians for both ascites (84% vs 50%,<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and pleural effusion (80% vs 34%,<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Similarly, higher POCUS use was observed in younger physicians. In conclusion, PE is frequently performed and rates of confidence are low for most PE signs, especially among young doctors and POCUS users. This detailed inventory suggests an ongoing shift towards POCUS integration in clinical practice.<\/jats:p>","DOI":"10.1007\/s11739-021-02781-1","type":"journal-article","created":{"date-parts":[[2021,6,20]],"date-time":"2021-06-20T10:02:28Z","timestamp":1624183348000},"page":"113-122","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Confidence and use of physical examination and point-of-care ultrasonography for detection of abdominal or pleural free fluid. A cross-sectional survey"],"prefix":"10.1007","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3934-0104","authenticated-orcid":false,"given":"Antonio","family":"Leidi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antoine","family":"Saudan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guillaume","family":"Soret","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Rouyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christophe","family":"Marti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00e9r\u00f4me","family":"Stirnemann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7528-7363","authenticated-orcid":false,"given":"Jean-Luc","family":"Reny","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivier","family":"Grosgurin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,6,20]]},"reference":[{"issue":"4","key":"2781_CR1","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1370\/afm.2420","volume":"17","author":"MA Kelly","year":"2019","unstructured":"Kelly MA, Freeman LK, Dornan T (2019) Family physicians\u2019 experiences of physical examination. Ann Fam Med 17(4):304\u2013310","journal-title":"Ann Fam Med"},{"issue":"4","key":"2781_CR2","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1016\/j.amjmed.2007.01.023","volume":"120","author":"CA Feddock","year":"2007","unstructured":"Feddock CA (2007) The lost art of clinical skills. Am J Med 120(4):374\u2013378","journal-title":"Am J Med"},{"issue":"6","key":"2781_CR3","doi-asserted-by":"publisher","first-page":"548","DOI":"10.1056\/NEJMp068013","volume":"354","author":"S Jauhar","year":"2006","unstructured":"Jauhar S (2006) The demise of the physical exam. N Engl J Med 354(6):548\u2013551","journal-title":"N Engl J Med"},{"issue":"5","key":"2781_CR4","first-page":"e1212","volume":"9","author":"T Asif","year":"2017","unstructured":"Asif T, Mohiuddin A, Hasan B, Pauly RR (2017) Importance Of Thorough Physical Examination: A Lost Art. Cureus 9(5):e1212","journal-title":"Cureus"},{"key":"2781_CR5","unstructured":"Simel DL, Rennie D, Keitz SA. The rational clinical examination: evidence-based clinical diagnosis: McGraw-Hill Medical New York, NY; 2009."},{"issue":"4","key":"2781_CR6","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1001\/jamacardio.2018.0001","volume":"3","author":"J Narula","year":"2018","unstructured":"Narula J, Chandrashekhar Y, Braunwald E (2018) Time to add a fifth pillar to bedside physical examination: inspection, palpation, percussion, auscultation, and insonation. JAMA Cardiol 3(4):346\u2013350","journal-title":"JAMA Cardiol"},{"key":"2781_CR7","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/1472-6920-14-73","volume":"14","author":"CM Haring","year":"2014","unstructured":"Haring CM, Cools BM, van der Meer JW, Postma CT (2014) Student performance of the general physical examination in internal medicine: an observational study. BMC Med Educ 14:73","journal-title":"BMC Med Educ"},{"issue":"4","key":"2781_CR8","doi-asserted-by":"publisher","first-page":"23","DOI":"10.7812\/TPP\/11-106","volume":"15","author":"S Sharma","year":"2011","unstructured":"Sharma S (2011) A single-blinded, direct observational study of PGY-1 interns and PGY-2 residents in evaluating their history-taking and physical-examination skills. Perm J 15(4):23\u201329","journal-title":"Perm J"},{"issue":"8","key":"2781_CR9","doi-asserted-by":"publisher","first-page":"1164","DOI":"10.1001\/jama.1982.03320330060027","volume":"247","author":"EL Cattau Jr","year":"1982","unstructured":"Cattau EL Jr, Benjamin SB, Knuff TE, Castell DO (1982) The accuracy of the physical examination in the diagnosis of suspected ascites. JAMA 247(8):1164\u20131166","journal-title":"JAMA"},{"issue":"19","key":"2781_CR10","doi-asserted-by":"publisher","first-page":"2645","DOI":"10.1001\/jama.1992.03480190087038","volume":"267","author":"JW Williams Jr","year":"1992","unstructured":"Williams JW Jr, Simel DL (1992) The rational clinical examination. Does this patient have ascites? How to divine fluid in the abdomen. JAMA 267(19):2645\u20132648","journal-title":"JAMA"},{"issue":"3","key":"2781_CR11","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1001\/jama.2008.937","volume":"301","author":"CL Wong","year":"2009","unstructured":"Wong CL, Holroyd-Leduc J, Straus SE (2009) Does this patient have a pleural effusion? JAMA 301(3):309\u2013317","journal-title":"JAMA"},{"issue":"3","key":"2781_CR12","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1016\/j.rmed.2006.07.014","volume":"101","author":"S Kalantri","year":"2007","unstructured":"Kalantri S, Joshi R, Lokhande T, Singh A, Morgan M, Colford JM Jr et al (2007) Accuracy and reliability of physical signs in the diagnosis of pleural effusion. Respir Med 101(3):431\u2013438","journal-title":"Respir Med"},{"issue":"12","key":"2781_CR13","doi-asserted-by":"publisher","first-page":"1818","DOI":"10.1001\/jamainternmed.2017.5048","volume":"177","author":"RB Liu","year":"2017","unstructured":"Liu RB, Donroe JH, McNamara RL, Forman HP, Moore CL (2017) The practice and implications of finding fluid during point-of-care ultrasonography: A review. JAMA Intern Med 177(12):1818\u20131825","journal-title":"JAMA Intern Med"},{"issue":"1","key":"2781_CR14","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.ccc.2013.08.002","volume":"30","author":"V Lobo","year":"2014","unstructured":"Lobo V, Weingrow D, Perera P, Williams SR, Gharahbaghian L (2014) Thoracic ultrasonography. Crit Care Clin 30(1):93-117v-vi","journal-title":"Crit Care Clin"},{"issue":"3","key":"2781_CR15","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1016\/j.ajem.2004.11.001","volume":"23","author":"SR Nazeer","year":"2005","unstructured":"Nazeer SR, Dewbre H, Miller AH (2005) Ultrasound-assisted paracentesis performed by emergency physicians vs the traditional technique: a prospective, randomized study. Am J Emerg Med 23(3):363\u2013367","journal-title":"Am J Emerg Med"},{"issue":"2","key":"2781_CR16","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1378\/chest.12-0447","volume":"143","author":"CJ Mercaldi","year":"2013","unstructured":"Mercaldi CJ, Lanes SF (2013) Ultrasound guidance decreases complications and improves the cost of care among patients undergoing thoracentesis and paracentesis. Chest 143(2):532\u2013538","journal-title":"Chest"},{"issue":"5","key":"2781_CR17","doi-asserted-by":"publisher","first-page":"e27","DOI":"10.1016\/j.annemergmed.2016.08.457","volume":"69","author":"U Guidelines","year":"2017","unstructured":"Guidelines U (2017) Emergency, point-of-care and clinical ultrasound guidelines in medicine. Ann Emerg Med 69(5):e27\u2013e54","journal-title":"Ann Emerg Med"},{"key":"2781_CR18","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-020-02284-5","author":"A Leidi","year":"2020","unstructured":"Leidi A, Rouyer F, Marti C, Reny JL, Grosgurin O (2020) Point of care ultrasonography from the emergency department to the internal medicine ward: current trends and perspectives. Intern Emerg Med. https:\/\/doi.org\/10.1007\/s11739-020-02284-5","journal-title":"Intern Emerg Med"},{"issue":"3","key":"2781_CR19","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/j.accpm.2017.06.008","volume":"37","author":"X Bobbia","year":"2018","unstructured":"Bobbia X, Abou-Badra M, Hansel N, Pes P, Petrovic T, Claret PG et al (2018) Changes in the availability of bedside ultrasound practice in emergency rooms and prehospital settings in France. Anaesth Crit Care Pain Med 37(3):201\u2013205","journal-title":"Anaesth Crit Care Pain Med"},{"issue":"9","key":"2781_CR20","doi-asserted-by":"publisher","first-page":"1052","DOI":"10.1007\/s11606-017-4071-5","volume":"32","author":"IWY Ma","year":"2017","unstructured":"Ma IWY, Arishenkoff S, Wiseman J, Desy J, Ailon J, Martin L et al (2017) Internal medicine point-of-care ultrasound curriculum: consensus recommendations from the canadian internal medicine ultrasound (CIMUS) Group. J Gen Intern Med 32(9):1052\u20131057","journal-title":"J Gen Intern Med"},{"key":"2781_CR21","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.ejim.2019.11.016","volume":"73","author":"J Torres-Macho","year":"2020","unstructured":"Torres-Macho J, Aro T, Bruckner I, Cogliati C, Gilja OH, Gurghean A et al (2020) Point-of-care ultrasound in internal medicine: A position paper by the ultrasound working group of the European federation of internal medicine. Eur J Intern Med 73:67\u201371","journal-title":"Eur J Intern Med"},{"issue":"1","key":"2781_CR22","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s13089-015-0035-3","volume":"7","author":"RA Hoppmann","year":"2015","unstructured":"Hoppmann RA, Rao VV, Bell F, Poston MB, Howe DB, Riffle S et al (2015) The evolution of an integrated ultrasound curriculum (iUSC) for medical students: 9-year experience. Crit Ultrasound J 7(1):18","journal-title":"Crit Ultrasound J"},{"key":"2781_CR23","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1186\/1472-6920-13-84","volume":"13","author":"HS Heinzow","year":"2013","unstructured":"Heinzow HS, Friederichs H, Lenz P, Schmedt A, Becker JC, Hengst K et al (2013) Teaching ultrasound in a curricular course according to certified EFSUMB standards during undergraduate medical education: a prospective study. BMC Med Educ 13:84","journal-title":"BMC Med Educ"},{"key":"2781_CR24","doi-asserted-by":"crossref","first-page":"w20201","DOI":"10.57187\/smw.2020.20201","volume":"150","author":"M Sohrmann","year":"2020","unstructured":"Sohrmann M, Berendonk C, Nendaz M, Bonvin R (2020) Swiss Working Group For Profiles I. Nationwide introduction of a new competency framework for undergraduate medical curricula: a collaborative approach. Swiss Med Wkly 150:w20201","journal-title":"Swiss Med Wkly"},{"issue":"6","key":"2781_CR25","doi-asserted-by":"publisher","first-page":"490","DOI":"10.7861\/clinmedicine.17-6-490","volume":"17","author":"AT Elder","year":"2017","unstructured":"Elder AT, McManus IC, Patrick A, Nair K, Vaughan L, Dacre J (2017) The value of the physical examination in clinical practice: an international survey. Clin Med (Lond) 17(6):490\u2013498","journal-title":"Clin Med (Lond)"},{"issue":"12","key":"2781_CR26","doi-asserted-by":"publisher","first-page":"1725","DOI":"10.1007\/s11606-007-0409-8","volume":"22","author":"EH Wu","year":"2007","unstructured":"Wu EH, Fagan MJ, Reinert SE, Diaz JA (2007) Self-confidence in and perceived utility of the physical examination: a comparison of medical students, residents, and faculty internists. J Gen Intern Med 22(12):1725\u20131730","journal-title":"J Gen Intern Med"},{"issue":"12","key":"2781_CR27","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1002\/jhm.2434","volume":"10","author":"NJ Soni","year":"2015","unstructured":"Soni NJ, Franco R, Velez MI, Schnobrich D, Dancel R, Restrepo MI et al (2015) Ultrasound in the diagnosis and management of pleural effusions. J Hosp Med 10(12):811\u2013816","journal-title":"J Hosp Med"},{"issue":"8","key":"2781_CR28","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1056\/NEJMra0909487","volume":"364","author":"CL Moore","year":"2011","unstructured":"Moore CL, Copel JA (2011) Current concepts point-of-care ultrasonography. New Engl J Med 364(8):749\u2013757","journal-title":"New Engl J Med"},{"issue":"10025","key":"2781_CR29","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.1016\/S0140-6736(16)30027-7","volume":"387","author":"PM Barrett","year":"2016","unstructured":"Barrett PM, Topol EJ (2016) To truly look inside. Lancet 387(10025):1268\u20131269","journal-title":"Lancet"},{"issue":"9","key":"2781_CR30","doi-asserted-by":"publisher","first-page":"e782","DOI":"10.1097\/CCM.0000000000003867","volume":"47","author":"A Rajamani","year":"2019","unstructured":"Rajamani A, Miu M, Huang S, Elbourne-Binns H, Pracher F, Gunawan S et al (2019) Impact of critical care point-of-care ultrasound short-courses on trainee competence. Crit Care Med 47(9):e782\u2013e784","journal-title":"Crit Care Med"},{"issue":"4","key":"2781_CR31","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1002\/aet2.10049","volume":"1","author":"DL Gold","year":"2017","unstructured":"Gold DL, Marin JR, Haritos D, Melissa Skaugset L, Kline JM, Stanley RM et al (2017) Pediatric emergency medicine physicians\u2019 use of point-of-care ultrasound and barriers to implementation: A Regional Pilot Study. AEM Educ Train 1(4):325\u2013333","journal-title":"AEM Educ Train"},{"issue":"4","key":"2781_CR32","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1080\/13814788.2016.1211105","volume":"22","author":"T Mengel-J\u00f8rgensen","year":"2016","unstructured":"Mengel-J\u00f8rgensen T, Jensen MB (2016) Variation in the use of point-of-care ultrasound in general practice in various European countries. Results of a survey among experts. Eur J Gen Pract 22(4):274\u2013277","journal-title":"Eur J Gen Pract"},{"key":"2781_CR33","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/s12874-019-0719-7","volume":"19","author":"L Weaver","year":"2019","unstructured":"Weaver L, Beebe TJ, Rockwood T (2019) The impact of survey mode on the response rate in a survey of the factors that influence Minnesota physicians\u2019 disclosure practices. BMC Med Res Methodol 19:73","journal-title":"BMC Med Res Methodol"},{"issue":"1","key":"2781_CR34","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1186\/s12875-020-01209-7","volume":"21","author":"D Touhami","year":"2020","unstructured":"Touhami D, Merlo C, Hohmann J, Essig S (2020) The use of ultrasound in primary care: longitudinal billing and cross-sectional survey study in Switzerland. BMC Fam Pract 21(1):127","journal-title":"BMC Fam Pract"}],"container-title":["Internal and Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11739-021-02781-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11739-021-02781-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11739-021-02781-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,31]],"date-time":"2022-12-31T20:17:46Z","timestamp":1672517866000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11739-021-02781-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,20]]},"references-count":34,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,1]]}},"alternative-id":["2781"],"URL":"https:\/\/doi.org\/10.1007\/s11739-021-02781-1","relation":{},"ISSN":["1828-0447","1970-9366"],"issn-type":[{"value":"1828-0447","type":"print"},{"value":"1970-9366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,20]]},"assertion":[{"value":"14 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 May 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 June 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}}]}}