Evaluation of transrectal examination of cervical diameter by palpation in dairy cows

The objective of the study was to evaluate the reliability of a manual assessment of cervical diameter through palpation. In an in vivo trial, 64 Holstein-Friesian cows between 2 and 5 d in milk (DIM) and between 21 and 27 DIM were examined by transrectal palpation by 3 investigators. For calculation of sensitivity and specificity, ultrasound-generated measurements were used as reference standard; a cervix >7.5 cm was categorized as large. The Pearson coefficient of correlation between the results of the 3 investigators and ultrasound-generated measurements was moderate (r = 0.71, 0.74, and 0.51). The estimates generated by palpation by the 3 different investigators did not differ and were similar to measurements obtained by ultrasound. The coefficient of variation (CV) between the investigators and ultrasound was high (20.9, 18.7, and 32.0%). The mean difference between the investigators and the ultrasound was 0.60 cm (95% confidence interval: −2.4 to 3.6). Sensitivity was 28.6, 42.9, and 42.9%, and specificity was 100, 96.2, and 92.6% for the ability of the 3 investigators, respectively, to detect the 7.5-cm cutoff by palpation. Overall sensitivity and specificity for all 3 investigators, considering ultrasound as the reference, were 37.5 and 96.2%, respectively. In vitro, 24 wooden cylinders were used to represent cervical diameter and to examine the reliability, as well as sensitivity and specificity, of manual assessment of different diameters. The Pearson coefficient of correlation between the results of the investigators (n = 11) and the actual diameters of the cylinders was 0.78. The CV between the investigators and the cylinders was 27.8%. The variation in the results was greater for cylinders with a larger diameter (3.5-cm diameter: mean ± standard deviation = 2.6 ± 0.9 cm; 10.5-cm diameter: mean ± standard deviation = 13.2 ± 4.0 cm). The estimate obtained by palpation for the 7.5-cm cylinder was 7.4 ± 2.1 cm. Sensitivity was 79.4% and specificity 92.5%. After training one group of investigators, sensitivity and specificity improved to 85.9 and 94.4%, respectively. Transrectal palpation of the cervical diameter shows moderate repeatability and correlation and high variation between the investigators and the reference standards. Variability increased with larger diameters.