Gade J, Kruse P, Andersen O T, Pedersen S B, Boesby S
Dept. of Surgical Gastroenterology D2, Copenhagen County's Glostrup Hospital, Copenhagen, Denmark.
Scand J Gastroenterol. 1998 Jul;33(7):773-7. doi: 10.1080/00365529850171756.
Abdominal auscultation has an important position in the physical examination of the abdomen. Little is known about rater agreement. The aim of this study was to describe rater agreement and thus, indirectly, the value of the examination.
In a semi-virtual setup 12 recordings of the intestinal sounds from 8 patients with acute abdominal pain and 4 healthy volunteers were presented to 100 physicians. The physicians were asked to characterize the intestinal sounds as normal or pathologic. Fisher's exact test was used for comparison between groups of physicians.
Overall, 72% of the answers with regard to healthy volunteers concluded that the sounds were normal (equalling agreement), whereas 64% of answers with regard to intestinal obstruction concluded that the sounds were pathologic (but agreement was higher due to agreement on wrong diagnosis in one case). Bowel sounds from colonic obstruction were diagnosed as pathologic in 94 of 100 answers. In peritonitis disagreement dominated. Specialists in gastrointestinal medicine diagnosed bowel obstruction significantly more poorly than non-specialists in gastrointestinal surgery (P < 0.05).
Rater agreement in normal subjects and in patients with intestinal obstruction was acceptable for a clinical examination. Abdominal auscultation is a helpful clinical examination in patients with acute abdominal pain.
腹部听诊在腹部体格检查中占有重要地位。目前对评估者间的一致性了解甚少。本研究旨在描述评估者间的一致性，从而间接了解该检查的价值。
在半虚拟环境中，向100名医生展示了8例急性腹痛患者和4名健康志愿者的12份肠鸣音录音。要求医生将肠鸣音特征描述为正常或病理性。采用Fisher精确检验对医生组间进行比较。
总体而言，关于健康志愿者的回答中，72%得出声音正常的结论（即一致性），而关于肠梗阻的回答中，64%得出声音为病理性的结论（但由于一例错误诊断的一致性，一致性更高）。100份回答中有94份将结肠梗阻的肠鸣音诊断为病理性。在腹膜炎中，分歧占主导。胃肠病专科医生对肠梗阻的诊断明显不如胃肠外科非专科医生（P < 0.05）。
对于临床检查而言，正常受试者和肠梗阻患者中评估者间的一致性是可以接受的。腹部听诊对急性腹痛患者是一项有用的临床检查。
