THE RELATION OF CONJUNCTIVAL PALLOR TO THE PRESENCE OF ANEMIA

OBJECTIVE: To determine the value of conjunctival pallor in ruling in or ruling out the presence of severe anemia (hemoglobin less than or e qual to 90 g/L) and to determine the interobserver agreement in assess ing this sign. DESIGN: Patients were prospectively assessed for pallor by at least one of three observers. All observations were made withou t information of the patient's hemoglobin value or of another observer 's assessment. SETTING: Tertiary-care, university-affiliate teaching h ospital, PATIENTS: Three hundred and two medical and surgical inpatien ts, MEASUREMENTS AND MAIN RESULTS; Likelihood ratios (LRs) calculated for conjunctival pallor present, borderline, and absent were as follow s: pallor present, LR 4.49 (95% confidence interval [CI] 1.80, 10.99): pallor borderline, LR 1.80 (95% CI 1.18, 2.62); pallor absent, LR 0.6 1 (95% CI 0.44, 0.80). Kappa scores of interobserver agreement between paired observers were 0.75 and 0.54. CONCLUSIONS: The presence of con junctival pallor, without other information suggesting anemia, is reas on enough to perform a hemoglobin determination. The absence of conjun ctival pallor is not likely to be of use in ruling out severe anemia. With well-defined criteria, interobserver agreement is good to very go od.