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	Since this article does not have an abstract, we have provided the first 95 words of the full text and any section headings.

To the Editor: In their Rational Clinical Examination article, Dr Wong and colleagues¹ addressed the question of whether a patient with pulmonary symptoms needs diagnostic imaging to rule out pleural effusion. Although they evaluated the accuracy of 8 physical examination findings, it was striking that they did not include tachypnea.²

Although there is interobserver variability in the measurement of respiratory rate,³ it is a legitimate part of the physical examination. It would be surprising if the sensitivity, specificity, and predictive accuracy of respiratory rate for pleural effusion have never been studied.

Financial Disclosures: None reported.

Dennis M. Manning, MD
manning.dennis@mayo.edu
Department of Medicine
Mayo Clinic College of Medicine
Rochester, Minnesota

1. Wong CL, Holroyd-Leduc J, Straus S. Does this patient have a pleural effusion? JAMA. 2009;301(3):309-317. FREE FULL TEXT 2. Gravelyn TR, Weg JG. Respiratory rate as an indicator of acute respiratory dysfunction. JAMA. 1980;244(10):1123-1125. FREE FULL TEXT 3. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified early warning score in medical admissions. QJM. 2001;94(10):521-526. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2009;301(19):1989.

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RELATED ARTICLE

Does This Patient Have a Pleural Effusion?
Camilla L. Wong, Jayna Holroyd-Leduc, and Sharon E. Straus
JAMA. 2009;301(3):309-317.
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Respiratory Rate and Diagnosis of Pleural Effusion—Reply
Camilla L. Wong, Jayna M. Holroyd-Leduc, and Sharon E. Straus
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