Abstract
Paediatricians often estimate liver size by palpating and percussing the liver edge in the right mid-clavicular line (RMCL). This measure is awkward in children, as determination of the RMCL is difficult - is measurement of the liver edge more accurate in the midline? 20 children aged between 6 months and 5 years were examined ‘blind’ by 5 practisinig clnicians on 3 separate occasions We observed poor repeatablity in measuring the RMCL between observers (15%>2standard deviations, SD), although the length ol the sternum, with defined, bony anatomical points, showed less variability (0.5%>2SD). Measurement in the midline showed greater repeatability between observers than in the RMCL (4%>2SD vs 8%>2SD). Estimation of the upper edge of the liver by percussion showed greatest variability (15%>2SD) Intra-observer variation followed the same pattern. Two children with exacerbations of asthma were followed by the examiners over 30 days: changes in the liver position were more accurately documented by measures made in the midline. We conclude that manual measurement of the hepar in the midline in children under 5 is more accurate than that in the RMCL.
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Michie, C., Adu, S., Wild, K. et al. HOW SHOULD WE ESTIMATE LIVER SIZE CLINICALLY?. Pediatr Res 35, 267 (1994). https://doi.org/10.1203/00006450-199402000-00079
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DOI: https://doi.org/10.1203/00006450-199402000-00079