In Reply. —We appreciate Dr Lederle's thoughtful comments regarding our article1 on the positive-predictive value of the clinical assessment of abdominal aortic aneurysm (AAA). To clarify our recommendations with respect to screening for and subsequent management of AAA, we address the issues raised by Lederle.
First, our study population included all residents of Olmsted County, Minnesota, who had medical record documentation of the suspicion of AAA by physical examination and who were referred for abdominal ultrasonography. Thus, our findings are directly relevant to the manner in which physicians presently practice medicine and presently examine patients for detection of AAA. We certainly agree with Lederle that the diagnostic performance of the physical examination for classification of AAA is an important area for research. Similarly to efforts to improve the performance of physical examination in breast cancer screening, 2 we should also support research to enhance the diagnostic performance of physical examination