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Ahmed S, Sultana S, Khan AM, Islam MS, Habib GMM, McLane IM, McCollum ED, Baqui AH, Cunningham S, Nair H. Digital auscultation as a diagnostic aid to detect childhood pneumonia: A systematic review. J Glob Health 2022; 12:04033. [PMID: 35493777 PMCID: PMC9024283 DOI: 10.7189/jogh.12.04033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Frontline health care workers use World Health Organization Integrated Management of Childhood Illnesses (IMCI) guidelines for child pneumonia care in low-resource settings. IMCI guideline pneumonia diagnostic criterion performs with low specificity, resulting in antibiotic overtreatment. Digital auscultation with automated lung sound analysis may improve the diagnostic performance of IMCI pneumonia guidelines. This systematic review aims to summarize the evidence on detecting adventitious lung sounds by digital auscultation with automated analysis compared to reference physician acoustic analysis for child pneumonia diagnosis. Methods In this review, articles were searched from MEDLINE, Embase, CINAHL Plus, Web of Science, Global Health, IEEExplore database, Scopus, and the ClinicalTrial.gov databases from the inception of each database to October 27, 2021, and reference lists of selected studies and relevant review articles were searched manually. Studies reporting diagnostic performance of digital auscultation and/or computerized lung sound analysis compared against physicians’ acoustic analysis for pneumonia diagnosis in children under the age of 5 were eligible for this systematic review. Retrieved citations were screened and eligible studies were included for extraction. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. All these steps were independently performed by two authors and disagreements between the reviewers were resolved through discussion with an arbiter. Narrative data synthesis was performed. Results A total of 3801 citations were screened and 46 full-text articles were assessed. 10 studies met the inclusion criteria. Half of the studies used a publicly available respiratory sound database to evaluate their proposed work. Reported methodologies/approaches and performance metrics for classifying adventitious lung sounds varied widely across the included studies. All included studies except one reported overall diagnostic performance of the digital auscultation/computerised sound analysis to distinguish adventitious lung sounds, irrespective of the disease condition or age of the participants. The reported accuracies for classifying adventitious lung sounds in the included studies varied from 66.3% to 100%. However, it remained unclear to what extent these results would be applicable for classifying adventitious lung sounds in children with pneumonia. Conclusions This systematic review found very limited evidence on the diagnostic performance of digital auscultation to diagnose pneumonia in children. Well-designed studies and robust reporting are required to evaluate the accuracy of digital auscultation in the paediatric population.
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Affiliation(s)
- Salahuddin Ahmed
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | | | - Ahad M Khan
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - Mohammad S Islam
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Child Health Research Foundation, Dhaka, Bangladesh
| | - GM Monsur Habib
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Bangladesh Primary Care Respiratory Society, Khulna, Bangladesh
| | | | - Eric D McCollum
- Global Program for Pediatric Respiratory Sciences, Eudowood Division of Paediatric Respiratory Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Abdullah H Baqui
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Steven Cunningham
- Department of Child Life and Health, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Harish Nair
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Du X, Allwood G, Webberley KM, Osseiran A, Wan W, Volikova A, Marshall BJ. A mathematical model of bowel sound generation. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2018; 144:EL485. [PMID: 30599659 DOI: 10.1121/1.5080528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/05/2018] [Indexed: 06/09/2023]
Abstract
Humans have been interested in bowel sounds and wondered about their origins for millennia. To better understand the phenomenon, a mathematical model of bowel sound generation was developed based on a spring-mass-damping system. This is similar to vocal folds models for speech. The bowel sound model has four parameters that link to bowel activities: the individual wave component, pressure index, component quantity, and component interval time. All types of bowel sound documented previously can be modelled by combining different values for these parameters. Further, a 2500 ms bowel sound incorporating all the common types was simulated to present the model's accuracy.
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Affiliation(s)
- Xuhao Du
- The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Perth, 6009, Australia
| | - Gary Allwood
- The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Perth, 6009, Australia
| | - K Mary Webberley
- The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Perth, 6009, Australia
| | - Adam Osseiran
- School of Engineering, Edith Cowan University, Perth, 6027, Australia , , , , , ,
| | - Wenchao Wan
- The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Perth, 6009, Australia
| | - Antonina Volikova
- The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Perth, 6009, Australia
| | - Barry J Marshall
- The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Perth, 6009, Australia
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Park JJ, Lee DW, Park KH, Jeong HS, Lee SH, Yun ZY. Comprehension of Lung Sounds for Family Medicine Residents in Daegu, Gyeongbuk. Korean J Fam Med 2010. [DOI: 10.4082/kjfm.2010.31.10.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Jung-Jae Park
- Department of Family Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Dong-Wook Lee
- Department of Family Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Ki-Heum Park
- Department of Family Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Hwee-Soo Jeong
- Department of Family Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Sin-Hyeung Lee
- Department of Family Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Zoo-Young Yun
- Department of Family Medicine, Dongguk University College of Medicine, Gyeongju, Korea
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Murphy R. Computerized multichannel lung sound analysis. Development of acoustic instruments for diagnosis and management of medical conditions. ACTA ACUST UNITED AC 2007; 26:16-9. [PMID: 17278768 DOI: 10.1109/memb.2007.289117] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Raymond Murphy
- Dept. of Pulmonary Medicine, Brigham & Women, Faulkner Hospital, Boston, MA 02130, USA.
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Staszko KF, Lincho C, Engelke VDC, Fiori NS, Silva KC, Nunes EI, Zhang L. Terminologia da ausculta pulmonar utilizada em publicações médicas brasileiras, no período de janeiro de 1980 a dezembro de 2003. J Bras Pneumol 2006. [DOI: 10.1590/s1806-37132006000500005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar a adequação de uso de termos semiológicos da ausculta pulmonar em publicações médicas brasileiras sobre doenças respiratórias, no período de janeiro de 1980 a dezembro de 2003. MÉTODOS: Realizou-se um estudo descritivo, analisando-se três revistas médicas: Jornal de Pneumologia, Jornal de Pediatria e Revista Médica Brasileira. Foram selecionados os artigos originais e relatos de casos sobre doenças respiratórias, de onde foram extraídos os termos semiológicos da ausculta pulmonar. Foi avaliada a adequação dos termos na descrição dos ruídos adventícios. RESULTADOS: Encontrou-se maior inadequação no uso dos termos de ruídos descontínuos, comparado com o uso dos termos de ruídos contínuos (87,7% versus 44%, p = 0,0000). Não houve diferença significativa entre relatos de pneumologistas e de outros especialistas quanto à inadequação no uso dos termos (56,5% versus 62,0%, p = 0,26). Também não observamos diferença significativa entre as regiões do país e os períodos antes e após a divulgação da nomenclatura internacional. CONCLUSÃO: O uso inadequado dos termos para descrever ruídos adventícios na ausculta pulmonar continua sendo um fenômeno freqüente e geral nas publicações médicas brasileiras.
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Leuppi JD, Dieterle T, Wildeisen I, Martina B, Tamm M, Koch G, Perruchoud AP, Leimenstoll BM. Can airway obstruction be estimated by lung auscultation in an emergency room setting? Respir Med 2005; 100:279-85. [PMID: 15964751 DOI: 10.1016/j.rmed.2005.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Accepted: 05/01/2005] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Lung auscultation is a central part of the physical examination at hospital admission. In this study, the physicians' estimation of airway obstruction by auscultation was determined and compared with the degree of airway obstruction as measured by FEV(1)/FVC values. METHODS Two hundred and thirty-three patients consecutively admitted to the medical emergency room with chest problems were included. After taking their history, patients were auscultated by an Internal Medicine registrar. The degree of airway obstruction had to be estimated (0=no, 1=mild, 2=moderate and 3=severe obstructed) and then spirometry was performed. Airway obstruction was defined as a ratio of FEV(1)/FVC <70%. The degree of airway obstruction was defined on FEV(1)/FVC as mild (FEV(1)/FVC <70% and >50%), moderate (FEV(1)/FVC <50% >30%) and severe (FEV(1)/FVC <30%). RESULTS One hundred and thirty-five patients (57.9%) had no sign of airway obstruction (FEV(1)/FVC >70%). Spirometry showed a mild obstruction in 51 patients (21.9%), a moderate obstruction in 27 patients (11.6%) and a severe obstruction in 20 patients (8.6%). There was a weak but significant correlation between FEV(1)/FVC and the auscultation-based estimation of airway obstruction in Internal Medicine Registrars (Spearman's rho=0.328; P<0.001). The sensitivity to detect airway obstruction by lung auscultation was 72.6% and the specificity only 46.3%. Thus, the negative predictive value was 68% and the positive predictive value 51%. In 27 patients (9.7%), airway obstruction was missed by lung auscultation. In these 27 cases, the severity of airway obstruction was mild in 20 patients, moderate in 5 patients and severe in 2 patients. In 82 patients (29.4%) with no sign of airway obstruction (FEV(1)/FVC >70%), airway obstruction was wrongly estimated as mild in 42 patients, as moderate in 34 patients and as severe in 6 patients, respectively. By performing multiple logistic regression, normal lung auscultation was a significant and independent predictor for not having an airway obstruction (OR 2.48 (1.43-4.28); P=0.001). CONCLUSION Under emergency room conditions, physicians can quite accurately exclude airway obstruction by auscultation. Normal lung auscultation is an independent predictor for not having an airway obstruction. However, airway obstruction is often overestimated by auscultation; thus, spirometry should be performed.
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Affiliation(s)
- Jörg D Leuppi
- Pneumology, Department of Internal Medicine, University Hospital Basel, Switzerland.
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Gross V, Dittmar A, Penzel T, Schüttler F, von Wichert P. The relationship between normal lung sounds, age, and gender. Am J Respir Crit Care Med 2000; 162:905-9. [PMID: 10988103 DOI: 10.1164/ajrccm.162.3.9905104] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Auscultation is one of the most important noninvasive and feasible methods for the detection of lung diseases. Systematic changes in breathing sounds with increasing age are of diagnostic importance. To investigate these changes, we recorded lung sounds taken from four locations in the posterior thorax of 162 subjects, together with airflow. The data were analyzed according to age, sex, and smoking habit. In order to describe the power spectrum of the lung sounds, we calculated mean and median frequency, frequency with the highest power, and a ratio (Q) of relative power of the two frequency bands of 330 to 600 Hz and 60 to 330 Hz. Linear regression analysis was used as a measurement of age-dependence of these variables. Significant differences in Q were found in men versus women (p < 0.05), but not in smokers versus nonsmokers. Within the groups, a small but significant correlation existed between Q and age (r(2) </= 0.1, p < 0.05). For both men and women, a slight increase of the relative power in the frequency band of 330 to 600 Hz was recorded with increasing age. However, on the basis of large individual variations, these small changes (DeltaQ approximately 5%, SD(Q) >/= +/- 5%) have no clinical significance and need not to be considered in the automatic detection of lung diseases by analyzing lung sounds.
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Affiliation(s)
- V Gross
- Department of Medicine, Philipps-University, Marburg, Germany.
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Whittaker AR, Lucas M, Carter R, Anderson K. Limitations in the use of median frequency for lung sound analysis. Proc Inst Mech Eng H 2000; 214:265-75. [PMID: 10902441 DOI: 10.1243/0954411001535769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this paper is to investigate methods of standardizing lung sound analysis, with a view to supplementing traditional spirometric air flow measurements to help in the diagnosis of asthma and to provide a measure of the effectiveness of treatment. Lung sounds were measured in nine patients with asthma and five control subjects, alongside air flow measurements of forced expiratory volume (FEV1) and forced vital capacity (FVC). The patients were administered the bronchodilator, salbutamol, to assess how effective these measurement techniques were for quantifying its effect. The results agree with previous studies, that analysis of lung sounds is a potentially useful tool for indicating air flow changes. The results, however, also demonstrate that the emerging standard of 'F50' or 'median frequency' should be treated with great caution because of its high sensitivity to the measurement frequency range. F50 is very unlikely to provide a reliable single indicator of lung condition.
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Affiliation(s)
- A R Whittaker
- Department of Mechanical Engineering, University of Glasgow, Scotland, UK
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Mangione S, Nieman LZ. Pulmonary auscultatory skills during training in internal medicine and family practice. Am J Respir Crit Care Med 1999; 159:1119-24. [PMID: 10194155 DOI: 10.1164/ajrccm.159.4.9806083] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We conducted a multicenter, cross-sectional assessment of pulmonary auscultatory skills among medical students and housestaff. Our study included 194 medical students, 18 pulmonary fellows, and 656 generalists-in-training from 17 internal medicine and 23 family practice programs in the Mid- Atlantic area of the United States. All participants listened to 10 pulmonary events recorded directly from patients, and answered by completing a multiple choice questionnaire. Proficiency scores were expressed as the percentage of respondents per year and type of training who correctly identified each event. In addition, we calculated a series of cumulative scores for sound recognition, disease identification, and basic knowledge of lung auscultation. Trainees' cumulative scores ranged from 0 to 85 for both internal medicine and family practice residents (median = 40). On average, internal medicine and family practice trainees recognized less than half of all respiratory events, with little improvement per year of training, and were not significantly better than medical students in their scores. Pulmonary fellows had the highest diagnostic and knowledge scores of all groups. These data indicate that there is very little difference in auscultatory proficiency between internal medicine and family practice trainees, and suggest the need for revisiting these time-honored skills during residency training.
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Affiliation(s)
- S Mangione
- Center for Research in Medical Education, Jefferson Medical College, Philadelphia, Pennsylvania, USA.
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Pasterkamp H, Kraman SS, Wodicka GR. Respiratory sounds. Advances beyond the stethoscope. Am J Respir Crit Care Med 1997; 156:974-87. [PMID: 9310022 DOI: 10.1164/ajrccm.156.3.9701115] [Citation(s) in RCA: 281] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- H Pasterkamp
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
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Pithie AD, Lammas DA, Fazal N, Rahelu M, Bartlett R, Gaston JS, Kumararatne DS. CD4+ cytolytic T cells can destroy autologous and MHC-matched macrophages but fail to kill intracellular Mycobacterium bovis-BCG. FEMS IMMUNOLOGY AND MEDICAL MICROBIOLOGY 1995; 11:145-54. [PMID: 7543788 DOI: 10.1111/j.1574-695x.1995.tb00101.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Mycobacterium bovis-BCG infected macrophages were exposed in vitro to PPD-stimulated T lymphocytes from tuberculin responsive donors or to a panel of mycobacterial-antigen specific CD4+ T cell clones. Both polyclonal and clonal T cells caused considerable antigen-specific lysis of autologous or MHC class II matched macrophages. However, lysis of infected macrophages did not significantly affect the number of viable mycobacteria which were released into the culture media from lysed macrophages. In tuberculosis, CD4+ cytolytic T cells may be primarily involved in tissue destruction and lack a significant role in acquired cellular immunity.
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Affiliation(s)
- A D Pithie
- Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, UK
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