Evaluation of Digital Auscultation to Diagnose Pneumonia in Children 2 to 35 Months of Age in a Clinical Setting in Kathmandu, Nepal: A Prospective Case–Control Study

Abstract

Objective?The objective of this study was to determine the diagnostic validity of digital chest auscultation to improve the differentiation of chest sounds associated with pneumonia in children. Methods?This is a prospective case?control study at two hospitals in Nepal. Cases had World Health Organization-defined pneumonia and were classified as radiologically confirmed or nonconfirmed based on radiographic findings. Controls had no respiratory complaints. The presence of crepitations in recorded lung sounds defined pneumonia. Radiologically confirmed pneumonia was the reference standard. Results?Sensitivity and specificity of digital auscultation were 56% (95% confidence interval [CI], 40?70%) and 73% (95% CI, 70?76%), respectively. Conclusion?Digital auscultation in conjunction with standardized grading of digital lung sounds has the potential to improve the specificity of pneumonia diagnosis, but further development of objective interpretation of lung sounds is needed.

Digital auscultation as a novel childhood pneumonia diagnostic tool for community clinics in Sylhet, Bangladesh: protocol for a cross-sectional study

“…The PERCH study enrolled children at a hospital setting and digital auscultation was performed by physicians, formally trained clinical assistants, or nurses, 40 another study enrolled children at a tertiary level centre in Lima, Peru, 42 and paediatricians recorded lung sounds in two tertiary level teaching hospitals in a study in Nepal. 43 Recording lung sounds in a first-level facility poses unique challenges in that clinics are typically crowded and the environment can be chaotic and noisy. Furthermore, ill children younger than 5 years of age can be especially uncooperative in uncomfortable ambulatory settings, leading to unique challenges like agitation, crying, vocalisations and the associated auscultation artefacts these create.…”

“…To our knowledge, this is the first study that will assess the recording of lung sounds of children younger than 5 years in first-level facilities by frontline workers in LMICs, where the burden of pneumonia and antibiotic use is high and diagnostic capacity is limited. The PERCH study enrolled children at a hospital setting and digital auscultation was performed by physicians, formally trained clinical assistants, or nurses,40 another study enrolled children at a tertiary level centre in Lima, Peru,42 and paediatricians recorded lung sounds in two tertiary level teaching hospitals in a study in Nepal 43. Recording lung sounds in a first-level facility poses unique challenges in that clinics are typically crowded and the environment can be chaotic and noisy.…”

A study protocol for community use of digital auscultation to improve diagnosis of paediatric pneumonia in Bangladesh

“…To our knowledge this is the first study that will assess the recording of lung sounds of children younger than five years in first-level facilities by frontline workers in LMICs, where the burden of pneumonia and antibiotic use is high and diagnostic capacity is limited. The PERCH study enrolled children at a hospital setting and digital auscultation was performed by physicians, formally trained clinical assistants, or nurses 40 , another study enrolled children at a tertiary level centre in Lima, Peru 42 , and paediatricians recorded lung sounds in two tertiary level teaching hospitals in a study in Nepal 43 . Recording lung sounds in a first-level facility poses unique challenges in that clinics are typically crowded and the environment can be chaotic and noisy.…”

Digital stethoscopes in paediatric medicine

“…In the respiratory field, this stethoscope has effectively been implemented to describe the frequency characteristics of normal pulmonary sounds in the paediatric population and was successful in describing a difference in sound characteristics between various parameters such as age, height and weight . Further to this it has been used in the detection of pneumonia . Features associated with swallowing in newborns have also been described .…”

“…In another investigation, a DS was used to assess preschool age children with a confirmed radiographic diagnosis of pneumonia. Although sensitivity for detection of pneumonia through crepitation detection was only 56% in comparison with plain chest x‐ray, the research displays a novel use for the technology as a bedside assessment tool . This was followed by a large multi‐country case–control study across Africa and Asia where the same technology was used again to identify abnormal pulmonary sounds in paediatric cases of pneumonia .…”