Digitally recorded and remotely classified lung auscultation compared with conventional stethoscope classifications among children aged 1-59 months enrolled in the Pneumonia Etiology Research for Child Health (PERCH) case-control study

Daniel E. Park, Nora L. Watson, Christopher Focht, Daniel Feikin, Laura L. Hammitt, W. Abdullah Brooks, Stephen R.C. Howie, Karen L. Kotloff, Orin S. Levine, Shabir A. Madhi, David R. Murdoch, Katherine L. O'Brien, J. Anthony G. Scott, Donald M. Thea, Tussanee Amorninthapichet, Juliet Awori, Charatdao Bunthi, Bernard Ebruke, Mounya Elhilali, Melissa HigdonLokman Hossain, Yasmin Jahan, David P. Moore, Justin Mulindwa, Lawrence Mwananyanda, Sathapana Naorat, Christine Prosperi, Somsak Thamthitiwat, Charl Verwey, Kathleen A. Jablonski, Melinda C. Power, Heather A. Young, Maria Deloria Knoll, Eric D. McCollum

Research output: Contribution to journalArticlepeer-review

Abstract

Background 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. Methods 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 2 tests and logistic regression adjusted for age, sex and site. Results 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). Conclusions 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.

Original languageEnglish (US)
Article numbere001144
JournalBMJ Open Respiratory Research
Volume9
Issue number1
DOIs
StatePublished - May 16 2022

Keywords

  • paediatric lung disaese
  • pneumonia
  • respiratory infection

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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