Medicine, Pulmonary Institute, Shaare Zedek Medical Center, and the Hebrew University Hadassah Medical School, Jerusalem, Israel
Pulmonary Institute, Shaare Zedek Medical Center, Jerusalem, Jerusalem, Israel.
BMJ Open Respir Res. 2020 Mar;7(1). doi: 10.1136/bmjresp-2020-000564.
In contrast with the technical progress of the stethoscope, lung sound terminology has remained confused, weakening the usefulness of auscultation. We examined how observer preferences regarding terminology and auscultatory skill influenced the choice of terms used to describe lung sounds.
Thirty-one staff physicians (SP), 65 residents (R) and 47 medical students (MS) spontaneously described the audio recordings of 5 lung sounds classified acoustically as: (1) normal breath sound; (2) wheezes; (3) crackles; (4) stridor and (5) pleural friction rub. A rating was considered correct if a correct term or synonym was used to describe it (term use ascribed to preference). The use of any incorrect terms was ascribed to deficient auscultatory skill.
Rates of correct sound identification were: (i) normal breath sound: SP=21.4%; R=11.6%; MS=17.1%; (ii) wheezes: SP=82.8%; R=85.2%; MS=86.4%; (iii) crackles: SP=63%; R=68.5%; MS=70.7%; (iv) stridor: SP=92.8%; R=90%; MS=72.1% and (v) pleural friction rub: SP=35.7%; R=6.2%; MS=3.2%. The 3 groups used 66 descriptive terms: 17 were ascribed to preferences regarding terminology, and 49 to deficient auscultatory skill. Three-group agreement on use of a term occurred on 107 occasions: 70 involved correct terms (65.4%) and 37 (34.6%) incorrect ones. Rate of use of recommended terms, rather than accepted synonyms, was 100% for the wheezes and the stridor, 55% for the normal breath sound, 22% for the crackles and 14% for the pleural friction rub.
The observers' ability to describe lung sounds was high for the wheezes and the stridor, fair for the crackles and poor for the normal breath sound and the pleural friction rub. Lack of auscultatory skill largely surpassed observer preference as a factor determining the choice of terminology. Wide dissemination of educational programs on lung auscultation (eg, self-learning via computer-assisted learning tools) is urgently needed to promote use of standardised lung sound terminology.
与听诊器的技术进步形成对比的是，肺部听诊术语仍然混乱，削弱了听诊的实用性。我们研究了观察者对术语和听诊技能的偏好如何影响描述肺部声音的术语选择。
31 名主治医生（SP）、65 名住院医师（R）和 47 名医学生（MS）自发描述了 5 种肺部声音的音频记录，这些声音在声学上被分类为：（1）正常呼吸音；（2）哮鸣音；（3）爆裂音；（4）喘鸣音和（5）胸膜摩擦音。如果使用正确的术语或同义词来描述它，则认为评分是正确的（归因于偏好的术语使用）。使用任何不正确的术语都归因于听诊技能不足。
正确识别声音的比率为：（i）正常呼吸音：SP=21.4%；R=11.6%；MS=17.1%；（ii）哮鸣音：SP=82.8%；R=85.2%；MS=86.4%；（iii）爆裂音：SP=63%；R=68.5%；MS=70.7%；（iv）喘鸣音：SP=92.8%；R=90%；MS=72.1%和（v）胸膜摩擦音：SP=35.7%；R=6.2%；MS=3.2%。这 3 组使用了 66 个描述性术语：17 个归因于术语偏好，49 个归因于听诊技能不足。在 107 次情况下，3 组在术语使用上达成一致：70 次涉及正确术语（65.4%），37 次涉及不正确术语（34.6%）。在使用推荐术语方面，而不是使用公认的同义词，哮鸣音和喘鸣音达到 100%，正常呼吸音达到 55%，爆裂音达到 22%，胸膜摩擦音达到 14%。
观察者描述肺部声音的能力对于哮鸣音和喘鸣音很高，对于爆裂音中等，对于正常呼吸音和胸膜摩擦音较差。听诊技能不足在很大程度上超过了观察者偏好，成为决定术语选择的因素。迫切需要广泛传播肺部听诊教育计划（例如，通过计算机辅助学习工具进行自我学习），以促进标准化肺部声音术语的使用。
