Department of Environmental and Occupational Health, The George Washington University, Washington, District of Columbia, USA
The Emmes Corporation, Rockville, Maryland, USA.
BMJ Open Respir Res. 2022 May;9(1). doi: 10.1136/bmjresp-2021-001144.
Diagnosis of pneumonia remains challenging. Digitally recorded and remote human classified lung sounds may offer benefits beyond conventional auscultation, but it is unclear whether classifications differ between the two approaches. We evaluated concordance between digital and conventional auscultation.
We collected digitally recorded lung sounds, conventional auscultation classifications and clinical measures and samples from children with pneumonia (cases) in low-income and middle-income countries. Physicians remotely classified recordings as crackles, wheeze or uninterpretable. Conventional and digital auscultation concordance was evaluated among 383 pneumonia cases with concurrently (within 2 hours) collected conventional and digital auscultation classifications using prevalence-adjusted bias-adjusted kappa (PABAK). Using an expanded set of 737 cases that also incorporated the non-concurrently collected assessments, we evaluated whether associations between auscultation classifications and clinical or aetiological findings differed between conventional or digital auscultation using χ tests and logistic regression adjusted for age, sex and site.
Conventional and digital auscultation concordance was moderate for classifying crackles and/or wheeze versus neither crackles nor wheeze (PABAK=0.50), and fair for crackles-only versus not crackles-only (PABAK=0.30) and any wheeze versus no wheeze (PABAK=0.27). Crackles were more common on conventional auscultation, whereas wheeze was more frequent on digital auscultation. Compared with neither crackles nor wheeze, crackles-only on both conventional and digital auscultation was associated with abnormal chest radiographs (adjusted OR (aOR)=1.53, 95% CI 0.99 to 2.36; aOR=2.09, 95% CI 1.19 to 3.68, respectively); any wheeze was inversely associated with C-reactive protein >40 mg/L using conventional auscultation (aOR=0.50, 95% CI 0.27 to 0.92) and with very severe pneumonia using digital auscultation (aOR=0.67, 95% CI 0.46 to 0.97). Crackles-only on digital auscultation was associated with mortality compared with any wheeze (aOR=2.70, 95% CI 1.12 to 6.25).
Conventional auscultation and remotely-classified digital auscultation displayed moderate concordance for presence/absence of wheeze and crackles among cases. Conventional and digital auscultation may provide different classification patterns, but wheeze was associated with decreased clinical severity on both.
肺炎的诊断仍然具有挑战性。数字化记录和远程人工分类的肺部声音可能提供比传统听诊更有益的信息，但目前尚不清楚这两种方法的分类是否存在差异。我们评估了数字化与传统听诊之间的一致性。
我们从低收入和中等收入国家的肺炎患儿（病例）中收集了数字化记录的肺部声音、传统听诊分类以及临床指标和样本。医生远程将记录分类为爆裂声、喘鸣或无法解读。使用校正后的偏倚调整后的 Kappa（PABAK）在 383 例同时（2 小时内）采集的传统和数字化听诊分类的肺炎病例中评估了传统和数字化听诊的一致性。使用一个包含了非同时采集评估的 737 例病例的扩展数据集，我们使用 χ 检验和逻辑回归（根据年龄、性别和地点进行调整）来评估听诊分类与临床或病因发现之间的关联是否在传统或数字化听诊之间存在差异。
对于有爆裂声和/或喘鸣与无爆裂声和/或喘鸣的分类，传统听诊和数字化听诊的一致性为中度（PABAK=0.50），对于爆裂声与无爆裂声的分类为一般（PABAK=0.30），喘鸣与无喘鸣的分类为一般（PABAK=0.27）。传统听诊中爆裂声更常见，而数字化听诊中喘鸣更常见。与无爆裂声和/或喘鸣相比，无论是传统听诊还是数字化听诊均仅出现爆裂声与异常胸片有关（校正比值比（aOR）为 1.53，95%CI 0.99 至 2.36；aOR 为 2.09，95%CI 1.19 至 3.68）；使用传统听诊，任何喘鸣与 C 反应蛋白>40mg/L 呈负相关（aOR 为 0.50，95%CI 0.27 至 0.92），而使用数字化听诊，任何喘鸣与严重肺炎呈负相关（aOR 为 0.67，95%CI 0.46 至 0.97）。与任何喘鸣相比，数字化听诊中仅出现爆裂声与死亡率相关（aOR 为 2.70，95%CI 1.12 至 6.25）。
在病例中，传统听诊和远程分类的数字化听诊在有无喘鸣和爆裂声方面显示出中度一致性。传统听诊和数字化听诊可能提供不同的分类模式，但喘鸣与两种听诊的临床严重程度降低有关。
