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
Authors: Park Daniel E , Watson Nora L , Focht Christopher , Feikin Daniel , Hammitt Laura L , Brooks W Abdullah , Howie Stephen R C , Kotloff Karen L , Levine Orin S , Madhi Shabir A , Murdoch David R , O'Brien Katherine L , Scott J Anthony G , Thea Donald M , Amorninthapichet Tussanee , Awori Juliet , Bunthi Charatdao , Ebruke Bernard , Elhilali Mounya , Higdon Melissa , Hossain Lokman , Jahan Yasmin , Moore David P , Mulindwa Justin , Mwananyanda Lawrence , Naorat Sathapana , Prosperi Christine , Thamthitiwat Somsak , Verwey Charl , Jablonski Kathleen A , Power Melinda C , Young Heather A , Deloria Knoll Maria , McCollum Eric D 
Published: May 2022

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 χ2tests 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.