Bedside evaluation of clubbing.

Sir,

I read with interest the recently published article by Mukherjee et al.[1] The bedside diagnosis of low grade clubbing by subjective assessment of finger especially that of hyponychial angle is difficult and the inter-observer agreement is highly variable (κ = 0.39 to 0.90).[1] Objective assessment of clubbing can be done by using cast of finger, use of slide caliper on living finger (to measure the phalangeal depth), or by the shadowgram technique. Myers and co-worker systematically reviewed the literature for precision and accuracy of clinical examination of clubbing and recommended to use the profile angle and phalangeal depth ratio (>1) as qualitative indices.[2] In the present article, the authors used the complicated shadowgram technique to measure the clubbing. However, the image of a finger can be easily captured by a digital camera (most of our mobile phones have the digital camera) at bedside and this image can be analyzed in a computer. The hyponychial angle, which is commonly assessed at bedside can be better measured from digital image.[3] The authors also did not mention references in Table 1.