Interrater Reliability of Pediatric Respiratory Auscultation Findings.

OBJECTIVE

To evaluate the interrater reliability of pediatric auscultatory findings as assessed by pediatric emergency medicine (PEM) physicians.

METHODS

We conducted a multicenter survey of physicians in 6 academic PEM divisions in the United States. Respondents listened to 15 audio clips of pediatric auscultatory sounds and classified them as normal or as having 1 or more adventitious sounds. We calculated Fleiss' κ to evaluate interrater reliability of auscultatory findings among respondents. We stratified results based on study site and years of experience.

RESULTS

Surveys were distributed to 128 physicians, with responses from 106 (83% response rate). Only the identification of normal breath sounds (κ = 0.46, 95% CI, 0.45-0.47) met threshold criteria for reliability. Other findings did not reach this threshold, including stridor (κ = 0.32, 95% CI, 0.31-0.33), wheeze (κ = 0.25, 95% CI, 0.24-0.25), crackles (κ = 0.15, 95% CI, 0.15-0.16), and rhonchi (κ = 0.15, 95% CI, 0.14-0.15). Some sites demonstrated greater intrarater reliability compared with others. Stratified by years of experience, only interpretation of normal breath sounds and stridor among physicians with 0 to 4 years of experience and the interpretation of normal breath sounds among physicians with 15 or more years of experience reached acceptable reliability. Compared with a reference standard, highest accuracy was noted in the interpretation of normal breath sounds (Accuracy =  0.85, 95% CI, 0.83-0.87).

CONCLUSION

We found poor interrater reliability in the interpretation of most pediatric breath sounds, except in the identification of normal breath sounds. These findings support a need for more robust approaches toward the accurate identification of respiratory pathology in children.