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The European Respiratory Society ERS lung sounds repository contains 20 audiovisual recordings of children and adults. The present study aimed at Rales crepitus aux bases of dating the interobserver variation in the classification of sounds into detailed and broader categories of crackles and wheezes. Recordings from 10 children Rales crepitus aux bases of dating 10 adults were classified into 10 predefined sounds by 12 observers, 6 paediatricians and 6 doctors for adult patients.

The majority Rales crepitus aux bases of dating observers agreed on the presence of at least one adventitious sound in 17 cases. The paediatricians did not reach better agreement on the child cases than the family physicians and specialists in adult medicine.

Descriptions of auscultation findings in broader terms were more reliably shared between observers compared to more detailed descriptions. The stethoscope is the quintessential iconic symbol of the medical profession. However, the reputation of this year-old instrument as a useful diagnostic tool in lung disease has been declining since chest radiography became available.

Guidelines from the Global initiative for Obstructive Lung Disease GOLD give little credit to lung sounds, and auscultation findings are not even listed among clues to early diagnosis of chronic obstructive pulmonary disease COPD.

Clinical studies have shown that lung auscultation is far from useless. Crackles Rales crepitus aux bases of dating radiographically confirmed pneumonia more strongly than any single respiratory symptom, 6 Rales crepitus aux bases of dating wheezes are heard more frequently with increasing severity of bronchial airflow limitation.

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In Rales crepitus aux bases of dating review on interobserver agreement on chest findings and Rales crepitus aux bases of dating diagnostic value published inthe authors found great variation between the published studies in terms of lung sounds, with Rales crepitus aux bases of dating fair to moderate agreement in the use of terminology.

This is important because lung auscultation is still commonly used in clinical practice, and the findings have an impact on the treatment of patients. Hearing crackles, for instance, strongly predicts antibiotic prescribing. These considerations prompted the institution of another ERS Task Force in to further standardise the use of lung sound terminology between clinicians and researchers from countries with different languages, based on a repository of audiovisual Rales crepitus aux bases of dating of lung auscultation.

An initial Rales crepitus aux bases of dating collection of 20 audiovisual recordings has recently been made available online as part of the ERS site Learning resources. We wanted to determine the interobserver variation in the classification of these sounds, with particular attention to more or less detailed descriptions Rales crepitus aux bases of dating adventitious sounds.

We also wanted to assess a potential influence of the professional background, that is, paediatrician versus family physician or adult medical specialist, on the classification of recordings from children and adults. This is a Rales crepitus aux bases of dating of interobserver variation between medical doctors in classifying lung sounds from video recordings performed at respiratory units in Spain, Greece, Norway, the Netherlands and Canada during The recording equipment was standardised, using video cameras with external microphone input Canon Legria HF series, Panasonic HC-X and quality electret microphones which were placed in the tubes of Rales crepitus aux bases of dating stethoscopes.

More details have already been published. The quality of 80 video recordings were rated by five of the six task force members, leaving out the member who had done the actual recordings, and they recommended whether or not to include the recording on the repository. Twenty recordings, 10 of children and 10 of adults, were judged to be of sufficient quality.

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Five of the task force members were paediatricians and one a general practitioner GP. Subsequently, the 20 recordings were classified by a convenient sample of six additional physicians who used the same online questionnaire. The observers downloaded the video files to their Rales crepitus aux bases of dating and were asked to classify the recordings according to recommended English language nomenclature fine and coarse crackles, high-pitched and low-pitched wheezes.

The questionnaire also offered free-text options to describe adventitious sounds by other terms. No instructions were given regarding the volume setting for audio playback. Agreement among the majority of observers seven or more on each of the 10 terms in each of the 20 cases was identified. Agreement in reporting other sounds than the 10 fixed options were elevated for sounds reported by seven or more observers to be present in the same case.

High-pitched expiratory wheeze was the predefined sound category most frequently reported by the observers, and in 5 of the 20 cases the majority seven or more of the observers reported this sound.

The majority of observers never reached this Rales crepitus aux bases of dating of agreement on the Rales crepitus aux bases of dating expiratory fine crackles, inspiratory or expiratory rhonchi, and inspiratory low-pitched wheezes. The term low-pitched wheezes was more frequently used than rhonchi and when these interchangeable terms were combined, better agreement was reached figure 1and it was even better when combined with high-pitched Rales crepitus aux bases of dating. Likewise, when fine and coarse crackles were combined into one category, agreement among the majority of the task force members occurred more frequently figure 1.

Such agreement on the presence of one or more of the four sound categories inspiratory and expiratory crackles and wheezes was reached in 16 of the 20 cases. The majority agreed on more than one of the four categories in 8 of the 20 cases, in 2 adult cases and 6 child cases. In one case, the majority of observers reported Rales crepitus aux bases of dating rub table 1.

The number among the 20 video recorded cases on which 7 or more of the 12 observers reached agreement on the presence of detailed and combined categories of crackles and wheezes. After combining fine and coarse crackles and high-pitched and low-pitched wheezes together with rhonchi, moderate agreement was reached for Rales crepitus aux bases of dating of the four categories figure 3.

An even better Rales crepitus aux bases of dating was reached after further lumping inspiratory and expiratory sounds, with kappas for crackles and wheezes of 0.

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The agreement tended to Rales crepitus aux bases of dating stronger on the adult cases than on the child cases. The paediatricians did Rales crepitus aux bases of dating reach better agreement on the child cases than the doctors familiar with examining adults figure 4.

Only slight to fair agreement was found for detailed descriptions of the adventitious sounds. In contrast, moderate to substantial agreement was reached for the combined categories of crackles and wheezes. For the wheezes, there was also moderate to substantial agreement when differentiating between inspiratory and expiratory sounds.

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The paediatricians did not agree better than the other doctors on the lung sounds from children. Overall, agreement on paediatric lung sounds was poorer than that on lung sounds from adults. Similar or somewhat stronger agreements on the presence of crackles and wheezes were found in Rales crepitus aux bases of dating study compared to most previous studies.

The most comparable previous study had observers watching video recordings and registering wheezing heard without a stethoscope. In that study, the multirater kappa agreement was 0. In many previous studies, detailed descriptions of the sounds have been based on computerised analysis.

Fine and coarse crackles have been identified by the duration of each crackle as shown on a phonogram. It is, for instance, possible that the amplitude of crackles plays a role in how the sound is perceived. It can also be difficult to differentiate between low-pitched and high-pitched wheezes by listening. Agreement on the presence of rhonchi was particularly Rales crepitus aux bases of dating in our study. This is in accordance with previous studies, where the agreement on rhonchi was much weaker than the agreement on crackles and wheezes.

Other characteristics of crackles and wheezes may be more important and also easier to identify than those applied in our classification. The number of crackles may be of importance and also the timing during inspiration.

Shim and Williams 38 Rales crepitus aux bases of dating that the three characteristics high pitch, intensity and spanning the entire phase were linked to decreased peak expiratory flow Rales crepitus aux bases of dating in patients with asthma. The 20 cases were from real patients with various lung diseases, both children and adults, and in eight cases more than Rales crepitus aux bases of dating category of adventitious sound was presented.

Six of the eight complex cases were recordings from children, and these might have been more difficult to classify than the recordings with only one kind of adventitious sound.

This may have led to poorer agreement in the paediatric cases than in the adult cases. To avoid misunderstanding on chest findings by auscultation, the use of combined terms of crackles and wheezes, or similar categories in other languages, should be encouraged when health workers communicate with each other. This does not mean that more precise terms should be discarded.

The video cases were selected from a larger group of files to ensure only high-quality recordings with few artefacts. Although artefacts are also common in real life, we expect that agreement on all recordings without the application of quality criteria would have been poorer than the results presented here.

Rales crepitus aux bases of dating mixture of observers increased the probability of transferable results. The task force members had some clinical information on the cases they had contributed to, but although this could have had some influence on their rating Rales crepitus aux bases of dating these cases, this knowledge could not have had any significant effects on the agreements. This indicates that improved agreements after lumping were statistically significant.

We found only slight to fair agreement for detailed descriptions of crackles and wheezes. Broader Rales crepitus aux bases of dating were more reliably shared between the observers.

Halvorsen, Magnus Hjortdahl and Anne H. HM takes final responsibility for the content of this manuscript, including the data and analysis. HP designed the questionnaire, and all authors classified the sounds. All authors approved the final version. Financial support has been given by The European Respiratory Society. Each centre obtained ethics approval at their institution and prepared consent Rales crepitus aux bases of Rales crepitus aux bases of dating in their required formats.

Provenance and peer review: Not commissioned; externally peer reviewed. No additional data are available. National Center for Biotechnology InformationU. Published online Apr Author information Article notes Copyright and License information Disclaimer.

Material and methods

Correspondence to Dr Hasse Melbye; on. For permission to use where not already granted under a licence please go to http: This article has been cited by other articles in PMC.

Methods Recordings from 10 children and 10 adults were classified into 10 predefined sounds by 12 observers, 6 paediatricians and 6 Rales crepitus aux bases of dating for adult patients. Results The majority of observers agreed on the presence of at least one adventitious sound in 17 cases. Conclusions Descriptions of auscultation findings in broader terms were more reliably shared between observers compared to more detailed descriptions. Although auscultation of Rales crepitus aux bases of dating lungs is important in medical diagnosis and decision-making, disagreement on the use of terms describing the sounds weakens the diagnostic value of the adventitious lung sounds for chest diseases.

Poor agreement was found when 12 observers classified lung sounds from video recordings of 20 patients with lung diseases into detailed categories, whereas acceptable agreement was obtained when the terms Rales crepitus aux bases of dating combined into broader categories. Material and methods This is a study of interobserver variation between medical doctors in classifying lung sounds from video recordings performed at respiratory units in Spain, Greece, Norway, the Netherlands and Canada during Statistical analysis Agreement among the majority of observers seven or more on each of the 10 terms in each of the 20 cases was identified.

Results Frequencies of agreement High-pitched expiratory wheeze was the predefined sound category most frequently reported by the observers, and in 5 of the 20 cases the majority seven or more of the observers reported this Rales crepitus aux bases of dating. Open in a separate window.

Bold font is used when 7 or more of the 12 observers agreed. Impact of age of cases and kind of physician The agreement tended to be stronger on the adult cases than on the child cases. Discussion Only slight to fair agreement was found for detailed descriptions of the adventitious sounds. Strengths and limitations The video Rales crepitus aux bases of dating were selected from a larger group of files to ensure only high-quality recordings with few artefacts.

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