Does level of training influence the ability to detect hepatosplenomegaly in children with leukemia?

BACKGROUND: Children with leukemia often have hepatosplenomegaly present. This can be diagnosed with physical examination and confirmed with ultrasound. We sought to determine if level of training influenced the ability to detect hepatosplenomegaly.

METHODS: All children diagnosed with leukemia during the past 5 years were reviewed. The training level of the examiner, the documentation of hepatosplenomegaly, and the ultrasound findings were collected and analyzed.

RESULTS: There were 245 examinations of the spleen and 254 of the liver. Splenomegaly was correctly diagnosed by medical students 54% of the time, by residents 81%, and by staff 79% of the time. First year residents diagnosed it correctly 68% of the time, R2s 64%, R3s 76% and R4s 86% of the time. Hepatomegaly was correctly diagnosed by medical students 44% of the time, by residents 73% and by staff 68% of the time. First year residents diagnosed it correctly 77% of the time, R2s 54%, R3s 81% and R4s 75% of the time.

CONCLUSIONS: Pediatric residents had the best ability to detect hepatosplenomegaly, and were better than staff and medical students, although this was not statistically significant.