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J Pediatr Infect Dis 2016; 11(02): 028-036
DOI: 10.1055/s-0036-1593749
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Evaluation of Digital Auscultation to Diagnose Pneumonia in Children 2 to 35 Months of Age in a Clinical Setting in Kathmandu, Nepal: A Prospective Case–Control Study

C. G. Scrafford
1   Health Sciences, Exponent, Inc., Washington, District of Columbia, United States
,
S. C. Basnet
2   Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
,
I. Ansari
3   Department of Pediatrics, Patan Hospital, Lalitpur, Kathmandu, Nepal
,
L. Shrestha
2   Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
,
S. Shrestha
3   Department of Pediatrics, Patan Hospital, Lalitpur, Kathmandu, Nepal
,
R. Ghimire
2   Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
,
J. Katz
4   Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
,
S. K. Khatry
5   Nepal Nutrition Intervention Project, Sarlahi, Kathmandu, Nepal
,
W. Checkley
4   Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
6   Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States
,
S. Basnet
2   Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
,
M. Shrestha
2   Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
,
S. B. Thapa
2   Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
,
P. Kansakar
3   Department of Pediatrics, Patan Hospital, Lalitpur, Kathmandu, Nepal
,
S. Puree
3   Department of Pediatrics, Patan Hospital, Lalitpur, Kathmandu, Nepal
,
V. Todi
3   Department of Pediatrics, Patan Hospital, Lalitpur, Kathmandu, Nepal
,
J. M. Tielsch
7   Department of Global Health, George Washington University, Washington, District of Columbia, United States
› Author Affiliations
Further Information

Publication History

06 July 2016

06 September 2016

Publication Date:
21 October 2016 (online)

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Abstract

Objective The objective of this study was to determine the diagnostic validity of digital chest auscultation to improve the differentiation of chest sounds associated with pneumonia in children.

Methods This is a prospective case–control study at two hospitals in Nepal. Cases had World Health Organization-defined pneumonia and were classified as radiologically confirmed or nonconfirmed based on radiographic findings. Controls had no respiratory complaints. The presence of crepitations in recorded lung sounds defined pneumonia. Radiologically confirmed pneumonia was the reference standard.

Results Sensitivity and specificity of digital auscultation were 56% (95% confidence interval [CI], 40–70%) and 73% (95% CI, 70–76%), respectively.

Conclusion Digital auscultation in conjunction with standardized grading of digital lung sounds has the potential to improve the specificity of pneumonia diagnosis, but further development of objective interpretation of lung sounds is needed.

Keywords

auscultation - children - pneumonia

Authors' Contribution

C.G.S. designed the study and data collection instruments, coordinated and supervised data collection at the two sites, reviewed the sound files, performed the initial analyses, and drafted the initial article. J.K. and J.M.T. conceptualized and designed the study, reviewed and finalized the data collection instruments, and reviewed and revised the article. J.M.T. obtained the funding for the study. S.B. coordinated data collection, served as a study pediatrician at the Institute of Medicine, Tribhuvan University, reviewed the sound files and radiographs, and reviewed and revised the article. L.S. coordinated data collection, served as a study pediatrician at the Institute of Medicine, Tribhuvan University, and reviewed and revised the article. S.S. and I.A. served as study pediatricians at the Patan Hospital, and reviewed and revised the article. R.G. reviewed the radiographs, and reviewed and revised the article. S.K.K. coordinated and supervised staff at the two sites and reviewed the article. W.C. reviewed and finalized the data collection instruments, participated in study design, and reviewed and revised the article. S.B., M.S., and S.B.T. served as study pediatricians at the Institute of Medicine, Tribhuvan University and reviewed and revised the article. P.K., S.P., and V.T. served as study pediatricians at the Patan Hospital, and reviewed and revised the article. All authors read and approved the final article.