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Listening panel agreement and characteristics of lung sounds digitally recorded from children aged 1–59 months enrolled in the Pneumonia Etiology Research for Child Health (PERCH) case–control study
  1. Eric D McCollum1,2,3,
  2. Daniel E Park3,
  3. Nora L Watson4,
  4. W Chris Buck5,
  5. Charatdao Bunthi6,
  6. Akash Devendra7,
  7. Bernard E Ebruke8,
  8. Mounya Elhilali9,
  9. Dimitra Emmanouilidou9,
  10. Anthony J Garcia-Prats10,
  11. Leah Githinji11,
  12. Lokman Hossain12,
  13. Shabir A Madhi13,14,
  14. David P Moore13,15,
  15. Justin Mulindwa16,
  16. Dan Olson17,
  17. Juliet O Awori18,
  18. Warunee P Vandepitte19,
  19. Charl Verwey13,15,
  20. James E West9,
  21. Maria D Knoll3,
  22. Katherine L O'Brien3,
  23. Daniel R Feikin3,20 and
  24. Laura L Hammit18
  1. 1 Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  2. 2 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Dhaka, Bangladesh
  3. 3 Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. 4 The Emmes Corporation, Rockville, Maryland, USA
  5. 5 Department of Pediatrics, University of California Los Angeles, Maputo, Mozambique
  6. 6 International Emerging Infections Program, Global Disease Detection Center, Thailand Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
  7. 7 National Health Service Highland, Inverness, UK
  8. 8 The Medical Research Council, Basse, The Gambia
  9. 9 Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, USA
  10. 10 Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
  11. 11 Division of Paediatric Pulmonology, University of Cape Town, Cape Town, South Africa
  12. 12 Respiratory Vaccines, Center for Vaccine Sciences, icddr,b, Dhaka, Bangladesh
  13. 13 Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
  14. 14 Department of Science and Technology/National Research Foundation, South African Research Chair: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
  15. 15 Department of Paediatrics, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
  16. 16 Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
  17. 17 Department of Pediatrics, Section of Infectious Disease, Center for Global Health, University of Colorado, Colorado, USA
  18. 18 Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
  19. 19 Queen Sirikit National Institute of Child Health, Rangsit University, Bangkok, Thailand
  20. 20 Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to Dr Eric D McCollum; emccoll3{at}jhmi.edu

Abstract

Introduction Paediatric lung sound recordings can be systematically assessed, but methodological feasibility and validity is unknown, especially from developing countries. We examined the performance of acoustically interpreting recorded paediatric lung sounds and compared sound characteristics between cases and controls.

Methods Pneumonia Etiology Research for Child Health staff in six African and Asian sites recorded lung sounds with a digital stethoscope in cases and controls. Cases aged 1–59 months had WHO severe or very severe pneumonia; age-matched community controls did not. A listening panel assigned examination results of normal, crackle, wheeze, crackle and wheeze or uninterpretable, with adjudication of discordant interpretations. Classifications were recategorised into any crackle, any wheeze or abnormal (any crackle or wheeze) and primary listener agreement (first two listeners) was analysed among interpretable examinations using the prevalence-adjusted, bias-adjusted kappa (PABAK). We examined predictors of disagreement with logistic regression and compared case and control lung sounds with descriptive statistics.

Results Primary listeners considered 89.5% of 792 case and 92.4% of 301 control recordings interpretable. Among interpretable recordings, listeners agreed on the presence or absence of any abnormality in 74.9% (PABAK 0.50) of cases and 69.8% (PABAK 0.40) of controls, presence/absence of crackles in 70.6% (PABAK 0.41) of cases and 82.4% (PABAK 0.65) of controls and presence/absence of wheeze in 72.6% (PABAK 0.45) of cases and 73.8% (PABAK 0.48) of controls. Controls, tachypnoea, >3 uninterpretable chest positions, crying, upper airway noises and study site predicted listener disagreement. Among all interpretable examinations, 38.0% of cases and 84.9% of controls were normal (p<0.0001); wheezing was the most common sound (49.9%) in cases.

Conclusions Listening panel and case–control data suggests our methodology is feasible, likely valid and that small airway inflammation is common in WHO pneumonia. Digital auscultation may be an important future pneumonia diagnostic in developing countries.

  • pneumonia
  • paediatric lung disaese
  • respiratory infection

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Twitter @tinylungsglobal

  • Contributors EDM conceptualised and designed the study, provided overall supervision of data collection, supervised the expert listening panel, collected lung sound reference sounds, drafted the initial manuscript, reviewed and revised the manuscript and approved the final manuscript as submitted. DEP conceptualised and designed the study, reviewed and revised the manuscript and approved the final manuscript as submitted. NLW conceptualised and designed the study, carried out the analyses, reviewed and revised the manuscript and approved the final manuscript as submitted. WCB interpreted lung sounds, reviewed and revised the manuscript and approved the final manuscript as submitted. CB supervised data collection at one site, reviewed and revised the manuscript and approved the final manuscript as submitted. AD interpreted lung sounds, reviewed and revised the manuscript and approved the final manuscript as submitted. BEE supervised data collection at one site, reviewed and revised the manuscript and approved the final manuscript as submitted. ME supervised denoising of the lung sounds, reviewed and revised the manuscript and approved the final manuscript as submitted. DE denoised the lung sounds, reviewed and revised the manuscript and approved the final manuscript as submitted. AJG-P interpreted lung sounds, reviewed and revised the manuscript and approved the final manuscript as submitted. LG interpreted lung sounds, reviewed and revised the manuscript and approved the final manuscript as submitted. LH supervised data collection at one site, reviewed and revised the manuscript and approved the final manuscript as submitted. SAM supervised data collection at one site, reviewed and revised the manuscript and approved the final manuscript as submitted. DPM supervised data collection at one site, reviewed and revised the manuscript and approved the final manuscript as submitted. JM collected lung sounds at one site, interpreted lung sounds, reviewed and revised the manuscript and approved the final manuscript as submitted. DO interpreted lung sounds, reviewed and revised the manuscript and approved the final manuscript as submitted. JOA supervised data collection at one site, reviewed and revised the manuscript and approved the final manuscript as submitted. WPV interpreted lung sounds, reviewed and revised the manuscript and approved the final manuscript as submitted. CV interpreted lung sounds, reviewed and revised the manuscript and approved the final manuscript as submitted. JEW supervised denoising of the lung sounds, reviewed and revised the manuscript and approved the final manuscript as submitted. MDK supervised the overall PERCH study and digital auscultation study, reviewed and revised the manuscript and approved the final manuscript as submitted. KLO supervised the overall PERCH study and digital auscultation study, reviewed and revised the manuscript and approved the final manuscript as submitted. DRF supervised the overall PERCH study and digital auscultation study, conceptualised and designed the digital auscultation study reviewed and revised the manuscript and approved the final manuscript as submitted. LLH supervised the overall PERCH study and digital auscultation study, conceptualised and designed the digital auscultation study reviewed and revised the manuscript and approved the final manuscript as submitted.

  • Funding This work was supported by grants from The Bill & Melinda Gates Foundation [OPP1084309, 48968] to the International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health. EDM also received support from the National Institutes of Health through the National Heart Lung and Blood Institute [T32HL072748-11] and the Fogarty International Center of the National Institutes of Health [K01TW009988].

  • Competing interests None declared.

  • Ethics approval Johns Hopkins School of Public Health and relevant local IRBs at the respective PERCH study sites.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All available data can be obtained by contacting the corresponding author.

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