Frank's sign is a clinically significant indicator of cardiovascular disease
While Frank's sign (diagonal earlobe crease) demonstrates a statistically significant association with cardiovascular disease and related conditions, systematic evaluations question its reliability and diagnostic accuracy as a standalone clinical indicator.
The retrieved literature contains conflicting evidence regarding the clinical utility of Frank's sign. While several studies and case reports find a statistically significant association between the diagonal earlobe crease and cardiovascular disease or related vascular conditions, rigorous diagnostic evaluations and systematic reviews conclude that its diagnostic accuracy is modest and insufficient for standalone clinical decision-making. Therefore, the claim is best classified as contested.
The evidence we hold leans evenly split
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official record 3x · fact-check 2x · hedged 1x · crowd & reference 1x
- Relationship between diagonal earlobe crease (Frank's sign) · peer-reviewed · supports · weight 1 · 2023
- Diagonal earlobe crease (Frank's sign) predicts obstructive · peer-reviewed · supports · weight 1 · 2023
- Exploring the Potential of Earlobe Crease as an Indicator of · peer-reviewed · supports · weight 1 · 2024
- Diagonal Earlobe Crease (Frank’s Sign) for Diagnosis of Coro · peer-reviewed · refutes · weight 1.3 · 2021
- Diagonal earlobe crease (Frank's sign) predicts obstructive · peer-reviewed · refutes · weight 1 · 2023
Relationship between diagonal earlobe crease (Frank's sign) and international index of erectile dysfunction score (IIEF-5). 2023. https://doi.org/10.22514/jomh.2023.116
This study found that diagonal earlobe crease is associated with atherogenic erectile dysfunction, supporting its role as a clinical indicator.
Krzysztof Więckowski, Tomasz Gallina, Andrzej Surdacki, Bernadeta Chyrchel. Diagonal Earlobe Crease (Frank’s Sign) for Diagnosis of Coronary Artery Disease: A Systematic Review of Diagnostic Test Accuracy Studies. 2021. https://doi.org/10.3390/jcm10132799
This systematic review concluded that the diagnostic accuracy of the diagonal earlobe crease for detecting coronary syndromes is insufficient to affect clinical management.
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B Gakovic, S A Neskovic, I Vranic, K Grujicic, A Ljubojevic, S Mijatovic, I Stankovic. Diagonal earlobe crease (Frank's sign) predicts obstructive coronary artery disease with modest accuracy. 2023. https://doi.org/10.1093/eurheartj/ehad655.1244
This study notes that bilateral Frank's sign is independently associated with coronary artery disease in a multivariate logistic regression model.
Exploring the Potential of Earlobe Crease as an Indicator of Coronary Artery Disease Risk: A Preliminary Case Study in Nepal. 2024. https://doi.org/10.33140/japm.09.02.01
This case study and review suggests that Frank's sign is a useful, simple physical finding for the early discovery of cardiovascular risk.
B Gakovic, S A Neskovic, I Vranic, K Grujicic, A Ljubojevic, S Mijatovic, I Stankovic. Diagonal earlobe crease (Frank's sign) predicts obstructive coronary artery disease with modest accuracy. 2023. https://doi.org/10.1093/eurheartj/ehad655.1244
This study found that despite an independent statistical association, the diagnostic accuracy of Frank's sign is modest, rendering it an unreliable clinical marker.
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