Aviles-Solis Juan Carlos, Vanbelle Sophie, Halvorsen Peder A, Francis Nick, Cals Jochen W L, Andreeva Elena A, Marques Alda, Piirilä Päivi, Pasterkamp Hans, Melbye Hasse
General Practice Research Unit, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Department of Methodology and Statistics, University of Maastricht, Maastricht, The Netherlands.
BMJ Open Respir Res. 2017 Dec 18;4(1):e000250. doi: 10.1136/bmjresp-2017-000250. eCollection 2017.
Lung auscultation is helpful in the diagnosis of lung and heart diseases; however, the diagnostic value of lung sounds may be questioned due to interobserver variation. This situation may also impair clinical research in this area to generate evidence-based knowledge about the role that chest auscultation has in a modern clinical setting. The recording and visual display of lung sounds is a method that is both repeatable and feasible to use in large samples, and the aim of this study was to evaluate interobserver agreement using this method.
With a microphone in a stethoscope tube, we collected digital recordings of lung sounds from six sites on the chest surface in 20 subjects aged 40 years or older with and without lung and heart diseases. A total of 120 recordings and their spectrograms were independently classified by 28 observers from seven different countries. We employed absolute agreement and kappa coefficients to explore interobserver agreement in classifying crackles and wheezes within and between subgroups of four observers.
When evaluating agreement on crackles (inspiratory or expiratory) in each subgroup, observers agreed on between 65% and 87% of the cases. Conger's kappa ranged from 0.20 to 0.58 and four out of seven groups reached a kappa of ≥0.49. In the classification of wheezes, we observed a probability of agreement between 69% and 99.6% and kappa values from 0.09 to 0.97. Four out of seven groups reached a kappa ≥0.62.
The kappa values we observed in our study ranged widely but, when addressing its limitations, we find the method of recording and presenting lung sounds with spectrograms sufficient for both clinic and research. Standardisation of terminology across countries would improve international communication on lung auscultation findings.
肺部听诊有助于诊断肺部和心脏疾病；然而，由于观察者间的差异，肺部声音的诊断价值可能受到质疑。这种情况也可能损害该领域的临床研究，从而无法产生关于胸部听诊在现代临床环境中的作用的循证知识。肺部声音的记录和可视化显示是一种在大样本中既具有可重复性又可行的方法，本研究的目的是使用这种方法评估观察者间的一致性。
我们使用置于听诊器管中的麦克风，从20名年龄在40岁及以上、患有或未患有肺部和心脏疾病的受试者胸部表面的六个部位收集肺部声音的数字记录。来自七个不同国家的28名观察者对总共120份记录及其频谱图进行了独立分类。我们采用绝对一致性和kappa系数来探讨四个观察者亚组内和亚组间在分类啰音和哮鸣音方面的观察者间一致性。
在评估每个亚组中关于啰音（吸气或呼气）的一致性时，观察者在65%至87%的病例上达成一致。Conger's kappa值范围为0.20至0.58，七个组中有四个组的kappa值≥0.49。在哮鸣音的分类中，我们观察到一致性概率在69%至99.6%之间，kappa值在0.09至0.97之间。七个组中有四个组的kappa值≥0.62。
我们在研究中观察到的kappa值范围广泛，但在考虑其局限性时，我们发现用频谱图记录和呈现肺部声音的方法对于临床和研究都足够。各国术语的标准化将改善关于肺部听诊结果的国际交流。
