Università Cattolica del Sacro Cuore, Rome, Italy.
Dipartimento di Neuroscienze, Organi di Senso e Torace, Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, 00168, Italy.
Respir Res. 2024 Sep 28;25(1):352. doi: 10.1186/s12931-024-02979-9.
Although crackles on chest auscultation represent a fundamental component of the diagnostic suspect for fibrotic interstitial lung disease (ILD), their reliability has not been properly studied. We assessed the agreement among respiratory physicians on the presence and changes over time of audible crackles collected in a prospective longitudinal cohort of patients with fibrotic ILD.
Lung sounds were digitally recorded at baseline and after 12 months at eight anatomical sites. Nine respiratory physicians blindly assessed randomized couples of recordings obtained from the same anatomical site at different timepoints. The physicians indicated the presence of crackles in individual recordings and which recording from each couple eventually had more intense crackles. Fleiss' kappa coefficient was used to measure inter- and intra-rater agreement.
Fifty-two patients, mostly with a diagnosis of IPF (n = 40, 76.9%) were prospectively enrolled between October 2019 and May 2021. The final acoustic dataset included 702 single recordings, corresponding to 351 couples of recordings from baseline and 12-months timepoints. Kappa coefficient was 0.57 (95% CI 0.55-0.58) for the presence of crackles and 0.42 (95% CI 0.41-0.43) for acoustic change. Intra-rater agreement, measured for three respiratory physicians on three repeated assessments, ranged from good to excellent for the presence of crackles (κ = 0.87, κ = 0.86, κ = 0.79), and from moderate to good for acoustic change (κ = 0.75, κ = 0.76, κ = 0.57).
Agreement between respiratory physicians for the presence of crackles and acoustic change was acceptable, suggesting that crackles represent a reliable acoustic finding in patients with fibrotic ILD. Their role as a lung-derived indicator of disease progression merits further studies.
虽然听诊时出现爆裂音是纤维性间质性肺疾病（ILD）的诊断线索的基本组成部分，但它们的可靠性尚未得到适当研究。我们评估了呼吸科医生在纤维性 ILD 前瞻性纵向队列患者中收集的可听爆裂音的存在及其随时间变化的一致性。
在 8 个解剖部位，在基线和 12 个月时对肺音进行数字记录。9 名呼吸科医生对来自不同时间点同一解剖部位的随机配对记录进行盲法评估。医生在单个记录中指示爆裂音的存在，并确定每对记录中哪一个记录的爆裂音更强烈。使用 Fleiss' kappa 系数测量组内和组间的一致性。
2019 年 10 月至 2021 年 5 月期间，前瞻性纳入了 52 名患者，主要诊断为特发性肺纤维化（n=40，76.9%）。最终的声学数据集包括 702 个单记录，对应于基线和 12 个月时的 351 对记录。爆裂音存在的 Kappa 系数为 0.57（95%CI 0.55-0.58），声音变化的 Kappa 系数为 0.42（95%CI 0.41-0.43）。三名呼吸科医生的三次重复评估的组内一致性，爆裂音的存在范围为良好到极好（κ=0.87、κ=0.86、κ=0.79），声音变化的存在范围为中度到良好（κ=0.75、κ=0.76、κ=0.57）。
呼吸科医生对爆裂音的存在和声音变化的一致性是可以接受的，这表明爆裂音是纤维性 ILD 患者可靠的声学发现。它们作为疾病进展的肺部来源指标的作用值得进一步研究。
