Is Pulmonary Auscultation Alone Sufficient for Clinical Practice

Abstract

Objective: The clinical examination is the basis for the diagnosis and rational choice of complementary tests. The aim of the study was to evaluate the performance of auscultation of the chest for screening of disease and for predicting the presence of abnormalities in the other domains of the chest examination. Methods: Patients with COPD, atelectasis, pleural effusion, pneumonia and controls were evaluated by two examiners in the absence of any clinical information, initially only with pulmonary auscultation, and then in the other domains of chest examination. Results: 192 physical examinations were performed in 104 patients. An abnormal pulmonary auscultation had a sensitivity of 85.2%, positive predictive value (PPV) of 84.1%, positive likelihood reason (LR) of 1.53 (95% CI; 1.16 to 2.01) and negative LR of 0.33 (95% CI; 0.2 to 0.56) to identify the presence of any disease, and also a positive LR of 2.23 (95% CI; 1.02 to 4.9) and a negative LR of 0.3 (95% CI; 0.17 to 0.51) to predict additional abnormalities. A normal auscultation showed low accuracy to identify healthy individuals, with sensitivity, specificity, NPV and PPV, respectively, of 44%, 43%, 41% and 46%. The agreement between the examiners considering normal versus abnormal findings showed kappa = 0.76 for any changes in the physical examination present (p < 0.0001). Conclusions: Auscultation of the chest alone, may not be a sufficient strategy to track diseases or establish whether continuity of the examination is necessary or not.