![]() We evaluated concordance between digital and conventional auscultation. Digitally recorded and remote human classified lung sounds may offer benefits beyond conventional auscultation, but it is unclear whether classifications differ between the two approaches. Conventional and digital auscultation may provide different classification patterns, but wheeze was associated with decreased clinical severity on both.Ībstract = "Background Diagnosis of pneumonia remains challenging. Conclusions Conventional auscultation and remotely-classified digital auscultation displayed moderate concordance for presence/absence of wheeze and crackles among cases. Crackles-only on digital auscultation was associated with mortality compared with any wheeze (aOR=2.70, 95% CI 1.12 to 6.25). Compared with neither crackles nor wheeze, crackles-only on both conventional and digital auscultation was associated with abnormal chest radiographs (adjusted OR (aOR)=1.53, 95% CI 0.99 to 2.36 aOR=2.09, 95% CI 1.19 to 3.68, respectively) any wheeze was inversely associated with C-reactive protein >40 mg/L using conventional auscultation (aOR=0.50, 95% CI 0.27 to 0.92) and with very severe pneumonia using digital auscultation (aOR=0.67, 95% CI 0.46 to 0.97). Crackles were more common on conventional auscultation, whereas wheeze was more frequent on digital auscultation. Results Conventional and digital auscultation concordance was moderate for classifying crackles and/or wheeze versus neither crackles nor wheeze (PABAK=0.50), and fair for crackles-only versus not crackles-only (PABAK=0.30) and any wheeze versus no wheeze (PABAK=0.27). Using an expanded set of 737 cases that also incorporated the non-concurrently collected assessments, we evaluated whether associations between auscultation classifications and clinical or aetiological findings differed between conventional or digital auscultation using χ 2 tests and logistic regression adjusted for age, sex and site. Conventional and digital auscultation concordance was evaluated among 383 pneumonia cases with concurrently (within 2 hours) collected conventional and digital auscultation classifications using prevalence-adjusted bias-adjusted kappa (PABAK). Physicians remotely classified recordings as crackles, wheeze or uninterpretable. Methods We collected digitally recorded lung sounds, conventional auscultation classifications and clinical measures and samples from children with pneumonia (cases) in low-income and middle-income countries. Additional details of examination maneuvers and their origins may be found in the Historical section.Background Diagnosis of pneumonia remains challenging. The physiologic basis of vocal sounds may be found in the Pathophysiology section. No single maneuver is both highly sensitive and specific in detection of pneumonia therefore, usually several maneuvers are performed to increase the accuracy. Several of the techniques for auscultation and percussion are classical parts of the physical examination with little data about predictive value or reproducibility. ![]() In this setting the following maneuvers have historically been used in making the diagnosis of pneumonia and may be of interest. The clinical likelihood of pneumonia increases when focal abnormalities such as crackles or asymmetry between lung fields are present. Note: If the above exam is normal, no further maneuvers are likely to contribute to the diagnosis of lung pathology. Assess for crackles in the lateral decubitus position (LDP). ![]() Assess for excursion depth during inspiration. ![]() Auscultate for presence of crackles, wheezes and rub, alternating between left and right lung.Since the complete pulmonary physical examination takes approximately ten minutes, for time-efficiency it is helpful to perform a screening exam, expanding techniques employed in a sequential fashion as indicated clinically: Screening Exam Techniques These are techniques of auscultation and percussion: There are many physical examination maneuvers described for evaluation of lung sounds. ![]()
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