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

Eric D McCollum^{1

2

3}, Daniel E Park³, Nora L Watson⁴, W Chris Buck⁵, Charatdao Bunthi⁶, Akash Devendra⁷, Bernard E Ebruke⁸, Mounya Elhilali⁹, Dimitra Emmanouilidou⁹, Anthony J Garcia-Prats¹⁰, Leah Githinji¹¹, Lokman Hossain¹², Shabir A Madhi^{13

14}, David P Moore^{13

15}, Justin Mulindwa¹⁶, Dan Olson¹⁷, Juliet O Awori¹⁸, Warunee P Vandepitte¹⁹, Charl Verwey^{13

15}, James E West⁹, Maria D Knoll³, Katherine L O'Brien³, Daniel R Feikin^{3

20}, Laura L Hammitt¹⁸

Affiliations

¹ Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
² Department of International Health, Johns Hopkins Bloomberg School of Public Health, Dhaka, Bangladesh.
³ Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁴ The Emmes Corporation, Rockville, Maryland, USA.
⁵ Department of Pediatrics, University of California Los Angeles, Maputo, Mozambique.
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 National Health Service Highland, Inverness, UK.
⁸ The Medical Research Council, Basse, The Gambia.
⁹ Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, USA.
¹⁰ Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa.
¹¹ Division of Paediatric Pulmonology, University of Cape Town, Cape Town, South Africa.
¹² Respiratory Vaccines, Center for Vaccine Sciences, icddr,b, Dhaka, Bangladesh.
¹³ Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
¹⁴ Department of Science and Technology/National Research Foundation, South African Research Chair: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa.
¹⁵ Department of Paediatrics, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
¹⁶ Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia.
¹⁷ Department of Pediatrics, Section of Infectious Disease, Center for Global Health, University of Colorado, Colorado, USA.
¹⁸ Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya.
¹⁹ Queen Sirikit National Institute of Child Health, Rangsit University, Bangkok, Thailand.
²⁰ Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

PMID: 28883927
PMCID: PMC5531306
DOI: 10.1136/bmjresp-2017-000193

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

Eric D McCollum et al. BMJ Open Respir Res. 2017.

. 2017 Jun 30;4(1):e000193.

doi: 10.1136/bmjresp-2017-000193. eCollection 2017.

Authors

Affiliations

¹ Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
² Department of International Health, Johns Hopkins Bloomberg School of Public Health, Dhaka, Bangladesh.
³ Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁴ The Emmes Corporation, Rockville, Maryland, USA.
⁵ Department of Pediatrics, University of California Los Angeles, Maputo, Mozambique.
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 National Health Service Highland, Inverness, UK.
⁸ The Medical Research Council, Basse, The Gambia.
⁹ Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, USA.
¹⁰ Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa.
¹¹ Division of Paediatric Pulmonology, University of Cape Town, Cape Town, South Africa.
¹² Respiratory Vaccines, Center for Vaccine Sciences, icddr,b, Dhaka, Bangladesh.
¹³ Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
¹⁴ Department of Science and Technology/National Research Foundation, South African Research Chair: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa.
¹⁵ Department of Paediatrics, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
¹⁶ Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia.
¹⁷ Department of Pediatrics, Section of Infectious Disease, Center for Global Health, University of Colorado, Colorado, USA.
¹⁸ Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya.
¹⁹ Queen Sirikit National Institute of Child Health, Rangsit University, Bangkok, Thailand.
²⁰ Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

PMID: 28883927
PMCID: PMC5531306
DOI: 10.1136/bmjresp-2017-000193

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.

Keywords: paediatric lung disaese; pneumonia; respiratory infection.

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Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Location and sequence of listening positions for digitally recorded lung sounds.

See this image and copyright information in PMC

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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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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References

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