Auscultating heart and breath sounds through patients’ gowns: who does this and does it matter?

Abstract

Background Doctors are taught to auscultate with the stethoscope applied to the skin, but in practice may be seen applying the stethoscope to the gown. Objectives To determine how often doctors auscultate heart and breath sounds through patients’ gowns, and to assess the impact of this approach on the quality of the sounds heard. Methods A sample of doctors in the west of Scotland were sent an email in 2014 inviting them to answer an anonymous questionnaire about how they auscultated heart and breath sounds. Normal heart sounds from two subjects were recorded through skin, through skin and gown, and through skin, gown and dressing gown. These were played to doctors, unaware of the origin of each recording, who completed a questionnaire about the method and quality of the sounds they heard. Results 206 of 445 (46%) doctors completed the questionnaire. 124 (60%) stated that they listened to patients’ heart sounds, and 156 (76%) to patients’ breath sounds, through patients’ gowns. Trainees were more likely to do this compared with consultants (OR 3.39, 95% CI 1.74 to 6.65). Doctors of all grades considered this practice affected the quality of the sounds heard. 32 doctors listened to the recorded heart sounds. 23 of the 64 (36%) skin and 23 of the 64 (36%) gown recordings were identified. The majority of doctors (74%) could not differentiate between skin or gown recordings, but could tell them apart from the double layer recordings (p=0.02). Trainees were more likely to hear artefactual added sounds (p=0.04). Conclusions Many doctors listen to patients’ heart and breath sounds through hospital gowns, at least occasionally. In a short test, most doctors could not distinguish between sounds heard through a gown or skin. Further work is needed to determine the impact of this approach to auscultation on the identification of murmurs and added sounds.

Suppression of Clothing-Induced Acoustic Attenuation in Robotic Auscultation

“…Unlike the related papers regarding robotic auscultation [ 11 , 12 , 13 , 14 , 15 ], the novelty of this study is that it develops a gender-free diagnosis platform performing autonomous auscultation over clothing and solves acoustic attenuation due to the clothing by applying an optimal contact force. Compared to our previous work [ 18 ], this study demonstrates the solid feasibility of robotic auscultation over clothing through validation with phantom studies with various type of clothing, which included thickness, material and layering combination, and with human trials with several clothing combinations.…”

“…Although the quality of sounds may be decreased by the presence of clothes, this can potentially be improved by adjusting the contact pressure of the stethoscope [ 14 ]. Additionally, recent electronic stethoscopes have been shown to be promising options for satisfying diagnostic sound quality, even over clothes [ 15 , 16 ].…”