The Ultrasound-Assisted Physical Examination in the Periodic Health Evaluation of the Elderly

In cardiac screening, the Cardiovascular Health Study Group14 obtained echocardiograms of 5201 senior adults in 4 communities and found that 190 (3.6%) had abnormal ejection fractions, and 26 (0.5%) had moderate to severe aortic stenosis. In a series of 200 consecutive transthoracic echocardiograms of patients who had already been evaluated with PE, Waggoner¹⁸ found a new diagnosis in 17 (8.5%) and additional information in 94 patients. Clinical assessment of systolic function was concordant in only 50% of patients with valvular disease.

Large studies of abdominal ultrasound screening have been conducted, especially in Russia and Japan. Filatov⁹ screened the abdomens and thyroids of 1092 industrial workers and found abnormalities in 26.1%. Oshibuchi¹⁹ screened the abdomens of 715 Japanese workers and found “gross abnormalities” in 44.5% of the men and 34.2% of the women. Vallencien²¹ and Jayson and Sanders²² found that many renal carcinomas are fortuitously discovered (37% and 61%, respectively) and that this group was likely to be at an earlier stage and have a better outcome than the group who presented with symptoms. Searching for abdominal aortic aneurysms, various authors^23-25 found a 6.5% to 10% prevalence in older and/or hypertensive groups.

In the pelvis, ultrasound has demonstrated utility in detection of endometrial, ovarian, and bladder malignancies.^26-31 Ciatto29 found 3 endometrial cancers in 2025 women; DePriest²⁶ (using transvaginal ultrasound) 6 ovarian cancers in 6470 women; Shimazui³⁰ 9 bladder tumors in 5706 examinees.

In each of these anatomical areas of the neck, heart, abdomen, and pelvis, ultrasound has demonstrated some utility in the detection of diseases, many of which are not very accessible to PE. Each of these diseases is by itself somewhat rare, however, so to screen for all of them with specialty studies is cumbersome and prohibitively costly. But if primary care physicians could accurately screen for all these conditions with a $30 test, it may be cost-effective and could improve the outcome of periodic health evaluations in senior citizens. Indeed, the US Preventive Services Task Force³⁸ states that the cost of screening tests is one of the prime considerations in considering them for recommendation, and in the case of abdominal aortic aneurysms in particular, if the cost of ultrasound screening could be brought low enough it would be preferred over PE.

Conclusions

Our small study is preliminary and descriptive but suggests that primary care physicians can increase their diagnostic yield by adding brief screening with ultrasound to their examinations. Whether that can be true of primary care physicians in general and whether we could demonstrate a value to this examination by improving the outcomes of seniors undergoing periodic health evaluations in large-scale studies remains speculative but invites further study.

Acknowledgments

We were assisted by the loan of an ultrasound machine from Medison Co, Ltd, and received technical and editorial assistance from the Office of Research and Development staff, State University of New York at Buffalo and the staff of David S. Clifford, MD. Also, special thanks to the patients from Dr Clifford’s practice who participated in this study.