The Accuracy of Physical Examination to Diagnose Anemia Among Patients Five Years or Older: A Systematic Review

Anemia remains a significant public health challenge, disproportionately impacting lower-income patients residing in areas of lesser healthcare resources. We sought to evaluate the accuracy of physical exam techniques to diagnose anemia among patients 5 years of age or older. A systematic review of 5 databases (MEDLINE via OVID, EMBASE, Scopus, Global Health and Global Health Archives, and WHO Global Index Medicus) was conducted. Studies that (1) compared non-invasive physical exam techniques with anemia diagnoses using standard laboratory measurements and (2) solely assessed or separately reported the diagnostic accuracy of physical exam techniques for patients 5 years or older were considered for inclusion. The diagnostic accuracies of individual and combinatorial physical exam techniques todiagnose anemia were documented. This systematic review was registered with PROSPERO. The systemic literature search yielded 6,457 unique studies after removal of duplicates. Fourteen studies were ultimately selected for inclusion. Eight studies solely assessed pregnant females, 4 solely assessed hospitalized patients, and 2 evaluated the general population. The diagnostic accuracy ranged widely for pallor assessments of conjunctivae (sensitivity: 19–97%, specificity: 65–100%), nailbed (sensitivity: 41–65%, specificity: 58–93%), and palms (sensitivity: 33–91%, specificity: 54–93%). Examining 9 or more sites leads to higher sensitivity (73.8–82.9%) and specificity (76.0–90.9%). No individual examination technique is superior to others for diagnosing anemia. Combinatorial approachs are associated with more acceptable accuracy measures, but improvements need to be balanced with time available for examination.