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, Department of Environmental and Occupational Health, The George Washington University, Washington, District of Columbia, USA danpark@gwu.edu.
Nora L. Watson, The Emmes Corporation, Rockville, Maryland, USA.
Christopher Focht, The Emmes Corporation, Rockville, Maryland, USA.
Daniel Feikin, Department of International Health, Johns Hopkins University International Vaccine Access Center, Baltimore, Maryland, USA.
Laura Hammit, Department of International Health, Johns Hopkins University International Vaccine Access Center, Baltimore, Maryland, USA.
W Abdullah Brooks, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka and Matlab, Bangladesh.
Stephen R. Howie, Medical Research Council Unit, Basse, Gambia.
Karen L. Kotloff, Department of Pediatrics, University of Maryland Center for Vaccine Development, Baltimore, Maryland, USA.
Orin S. Levine, Department of International Health, Johns Hopkins University International Vaccine Access Center, Baltimore, Maryland, USA.
Shabir A. Madhi, South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
David R. Murdoch, Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand.
Katherine L. O'Brien, Department of International Health, Johns Hopkins University International Vaccine Access Center, Baltimore, Maryland, USA.
J Anthony Scott, Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya.
Donald M. Thea, Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.
Tussanee Amorninthapichet, Sakaeo Crown Prince Hospital, Royal Thai Government Ministry of Public Health, Sakaeo, Thailand.
Juliet Awori, Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya.
Charatdao Bunthi, Division of Global Health Protection, Thailand Ministry of Public Health - US CDC Collaboration, Royal Thai Government Ministry of Public Health, Bangkok, Thailand.
Bernard Ebruke, Medical Research Council Unit, Basse, Gambia.
Mounya Elhilali, Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA.
Melissa Higdon, Department of International Health, Johns Hopkins University International Vaccine Access Center, Baltimore, Maryland, USA.
Lokman Hossain, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka and Matlab, Bangladesh.
Yasmin Jahan, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka and Matlab, Bangladesh.
David P. Moore, South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Justin Mulindwa, Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia.
Lawrence Mwananyanda, Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.
Sathapana Naorat, RTI International, Research Triangle Park, North Carolina, USA.
Christine Prosperi, Department of International Health, Johns Hopkins University International Vaccine Access Center, Baltimore, Maryland, USA.
Somsak Thamthitiwat, Division of Global Health Protection, Thailand Ministry of Public Health - US CDC Collaboration, Royal Thai Government Ministry of Public Health, Nonthaburi, Thailand.
Charl Verwey, South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
Kathleen A. Jablonski, The George Washington University Biostatistics Center, Rockville, Maryland, USA.
Melinda C. Power, Department of Epidemiology, The George Washington University, Washington, District of Columbia, USA.
Heather A. Young, Department of Epidemiology, The George Washington University, Washington, District of Columbia, USA.

Document Type

Journal Article

Publication Date

5-1-2022

Journal

BMJ open respiratory research

Volume

9

Issue

1

DOI

10.1136/bmjresp-2021-001144

Keywords

paediatric lung disaese; pneumonia; respiratory infection

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 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.

Department

Environmental and Occupational Health

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