Listening panel agreement and characteristics of lung sounds digitally recorded from children aged 1–59 months enrolled in the Pneumonia Etiology Research for Child Health (PERCH) case–control study

Abstract

IntroductionPaediatric lung sound recordings can be systematically assessed, but methodological feasibility and validity is unknown, especially from developing countries. We examined the performance of acoustically interpreting recorded paediatric lung sounds and compared sound characteristics between cases and controls.MethodsPneumonia Etiology Research for Child Health staff in six African and Asian sites recorded lung sounds with a digital stethoscope in cases and controls. Cases aged 1–59 months had WHO severe or very severe pneumonia; age-matched community controls did not. A listening panel assigned examination results of normal, crackle, wheeze, crackle and wheeze or uninterpretable, with adjudication of discordant interpretations. Classifications were recategorised into any crackle, any wheeze or abnormal (any crackle or wheeze) and primary listener agreement (first two listeners) was analysed among interpretable examinations using the prevalence-adjusted, bias-adjusted kappa (PABAK). We examined predictors of disagreement with logistic regression and compared case and control lung sounds with descriptive statistics.ResultsPrimary listeners considered 89.5% of 792 case and 92.4% of 301 control recordings interpretable. Among interpretable recordings, listeners agreed on the presence or absence of any abnormality in 74.9% (PABAK 0.50) of cases and 69.8% (PABAK 0.40) of controls, presence/absence of crackles in 70.6% (PABAK 0.41) of cases and 82.4% (PABAK 0.65) of controls and presence/absence of wheeze in 72.6% (PABAK 0.45) of cases and 73.8% (PABAK 0.48) of controls. Controls, tachypnoea, >3 uninterpretable chest positions, crying, upper airway noises and study site predicted listener disagreement. Among all interpretable examinations, 38.0% of cases and 84.9% of controls were normal (p<0.0001); wheezing was the most common sound (49.9%) in cases.ConclusionsListening panel and case–control data suggests our methodology is feasible, likely valid and that small airway inflammation is common in WHO pneumonia. Digital auscultation may be an important future pneumonia diagnostic in developing countries.

Challenges in the diagnosis of paediatric pneumonia in intervention field trials: recommendations from a pneumonia field trial working group

“…WHO guidelines for frontline health-care providers and community health workers do not include lung auscultation in the diagnostic criteria for child pneumonia. 31,63 Although digital stethoscopes and automated lung sound analysis are emerging areas with the potential to overcome these educational and interpretation limitations, 64,65 additional research is needed before field implementation is feasible.…”

Digital auscultation in PERCH: Associations with chest radiography and pneumonia mortality in children

“…17,18 2.2 | Digital auscultation sampling in PERCH Sampling of children for lung sound recordings varied by site. 14…”

“…All study staff were trained to record lung sounds according to a protocol using a commercial digital stethoscope (ThinkLabs ds32a). 14 (Figure 1). The overall recording duration was approximately 1-2 min.…”

“…Johns Hopkins University sound engineers filtered environmental sound contaminations from recordings using an innovative automated multiband denoising filter. 12,14 Lung sounds were classified according to a previously described methodology. 14 In brief, each lung sound was randomly assigned to two members of an expert listening panel of eight pediatricians and pediatric-experienced physicians who were standardized to interpret lung sounds according to a reference panel of previously recorded lung sounds.…”

Digital stethoscopes in paediatric medicine

“…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 . The study concluded that use of this technology in low‐resource settings is feasible and interpretations from the sound recordings can reliably be achieved.…”